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Kawashima A, Furukawa T, Imaizumi T, Morohashi A, Hara M, Yamada S, Hama M, Kawaguchi A, Sato K. Predictive Models for Palliative Care Needs of Advanced Cancer Patients Receiving Chemotherapy. J Pain Symptom Manage 2024; 67:306-316.e6. [PMID: 38218414 DOI: 10.1016/j.jpainsymman.2024.01.009] [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: 10/11/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
CONTEXT Early palliative care is recommended within eight-week of diagnosing advanced cancer. Although guidelines suggest routine screening to identify cancer patients who could benefit from palliative care, implementing screening can be challenging due to understaffing and time constraints. OBJECTIVES To develop and evaluate machine learning models for predicting specialist palliative care needs in advanced cancer patients undergoing chemotherapy, and to investigate if predictive models could substitute screening tools. METHODS We conducted a retrospective cohort study using supervised machine learning. The study included patients aged 18 or older, diagnosed with metastatic or stage IV cancer, who underwent chemotherapy and distress screening at a designated cancer hospital in Japan from April 1, 2018, to March 31, 2023. Specialist palliative care needs were assessed based on distress screening scores and expert evaluations. Data sources were hospital's cancer registry, health claims database, and nursing admission records. The predictive model was developed using XGBoost, a machine learning algorithm. RESULTS Out of the 1878 included patients, 561 were analyzed. Among them, 114 (20.3%) exhibited needs for specialist palliative care. After under-sampling to address data imbalance, the models achieved an Area Under the Curve (AUC) of 0.89 with 95.8% sensitivity and a specificity of 71.9%. After feature selection, the model retained five variables, including the patient-reported pain score, and showcased an 0.82 AUC. CONCLUSION Our models could forecast specialist palliative care needs for advanced cancer patients on chemotherapy. Using five variables as predictors could replace screening tools and has the potential to contribute to earlier palliative care.
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Affiliation(s)
- Arisa Kawashima
- Division of Integrated Health Sciences (A.K. K.S.), Department of Nursing for Advanced Practice, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Social Science (A.K.), Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Japan..
| | - Taiki Furukawa
- Medical IT Center (T.F.), Nagoya University Hospital, Nagoya, Japan; Department of Respiratory Medicine (T.F.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Imaizumi
- Department of Advanced Medicine (T.I., A.M.), Nagoya University Hospital, Nagoya, Japan
| | - Akemi Morohashi
- Department of Advanced Medicine (T.I., A.M.), Nagoya University Hospital, Nagoya, Japan
| | - Mariko Hara
- Department of Clinical Oncology and Chemotherapy (M.H., S.Y., M.H., A.K.), Nagoya University Hospital, Nagoya, Japan
| | - Satomi Yamada
- Department of Clinical Oncology and Chemotherapy (M.H., S.Y., M.H., A.K.), Nagoya University Hospital, Nagoya, Japan
| | - Masayo Hama
- Department of Clinical Oncology and Chemotherapy (M.H., S.Y., M.H., A.K.), Nagoya University Hospital, Nagoya, Japan
| | - Aya Kawaguchi
- Department of Clinical Oncology and Chemotherapy (M.H., S.Y., M.H., A.K.), Nagoya University Hospital, Nagoya, Japan
| | - Kazuki Sato
- Division of Integrated Health Sciences (A.K. K.S.), Department of Nursing for Advanced Practice, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Spooner C, Vivat B, White N, Bruun A, Rohde G, Kwek PX, Stone P. What outcomes do studies use to measure the impact of prognostication on people with advanced cancer? Findings from a systematic review of quantitative and qualitative studies. Palliat Med 2023; 37:1345-1364. [PMID: 37586031 PMCID: PMC10548779 DOI: 10.1177/02692163231191148] [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] [Indexed: 08/18/2023]
Abstract
BACKGROUND Studies evaluating the impact of prognostication in advanced cancer patients vary in the outcomes they measure, and there is a lack of consensus about which outcomes are most important. AIM To identify outcomes previously reported in prognostic research with people with advanced cancer, as a first step towards constructing a core outcome set for prognostic impact studies. DESIGN A systematic review was conducted and analysed in two subsets: one qualitative and one quantitative. (PROSPERO ID: CRD42022320117; 29/03/2022). DATA SOURCES Six databases were searched from inception to September 2022. We extracted data describing (1) outcomes used to measure the impact of prognostication and (2) patients' and informal caregivers' experiences and perceptions of prognostication in advanced cancer. We classified findings using the Core Outcome Measures in Effectiveness Trials (COMET) initiative taxonomy, along with a narrative description. We appraised retrieved studies for quality, but quality was not a basis for exclusion. RESULTS We identified 42 eligible studies: 32 quantitative, 6 qualitative, 4 mixed methods. We extracted 70 outcomes of prognostication in advanced cancer and organised them into 12 domains: (1) survival; (2) psychiatric outcomes; (3) general outcomes; (4) spiritual/religious/existential functioning/wellbeing, (5) emotional functioning/wellbeing; (6) cognitive functioning; (7) social functioning; (8) global quality of life; (9) delivery of care; (10) perceived health status; (11) personal circumstances; and (12) hospital/hospice use. CONCLUSION Outcome reporting and measurement varied markedly across the studies. A standardised approach to outcome reporting in studies of prognosis is necessary to enhance data synthesis, improve clinical practice and better align with stakeholders' priorities.
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Affiliation(s)
- Caitlin Spooner
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bella Vivat
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Gudrun Rohde
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Pei Xing Kwek
- University College Dublin School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Ozdemir S, Lee JJ, Yang GM, Malhotra C, Teo I, Pham NT, Manalo MF, Hapuarachchi T, Mariam L, Rahman R, Finkelstein E. Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia. J Pain Symptom Manage 2022; 64:e195-e201. [PMID: 35705117 DOI: 10.1016/j.jpainsymman.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/09/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia. OBJECTIVES This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs. METHODS This cross-sectional study analyzed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression. RESULTS Overall PC awareness was 30.8% (n = 234). Patients with higher education (OR = 1.0; CI = 1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR = 2.0; CI = 1.2,3.3), awareness of disease severity (OR = 1.5; CI = 1.0,2.2), and higher pain severity (OR = 1.1; CI = 1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR = 0.5; CI = 0.3,0.8) or uninformed (OR = 0.5; CI = 0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n = 82) among those with PC awareness, and 47.8% (n = 66) among patients recommended PC by a healthcare professional (n = 138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n = 43; 33.9%), and having insufficient information about PC (n = 41; 32.3%). CONCLUSION The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.
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Affiliation(s)
- Semra Ozdemir
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore.
| | - Jia Jia Lee
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Grace Meijuan Yang
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Division of Palliative and Supportive Care (M.Y.), National Cancer Centre Singapore, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
| | | | | | | | - Lubna Mariam
- Department of Radiation Oncology (L.M.), National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
| | - Rubayat Rahman
- Department of Palliative Medicine (R.R.), Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Eric Finkelstein
- Lien Centre for Palliative Care (S.O., J.J.L., M.Y., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore; Programme in Health Services & Systems Research (S.O., J.J.L., C.M., I.T., E.F.), Duke-NUS Medical School, Singapore
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Myint AT, Tiraphat S, Jayasvasti I, Hong SA, Kasemsup V. Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157887. [PMID: 34360179 PMCID: PMC8345377 DOI: 10.3390/ijerph18157887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.
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Affiliation(s)
- Aye Tinzar Myint
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Sariyamon Tiraphat
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Correspondence: ; Tel.: +66-2-441-9040-3 (ext. 54); Fax: +66-2-441-9044
| | - Isareethika Jayasvasti
- Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand;
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Vijj Kasemsup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Kye SY, Han KT, Choi J, Jho HJ, Park SJ, Song IG, Nam EJ, Chang YJ. Associations Between the Intention to Use Early Palliative Care, Sources of Information, and Attitudes Toward a Good Death in Korean Adults. J Pain Symptom Manage 2020; 60:503-511. [PMID: 32335202 DOI: 10.1016/j.jpainsymman.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Providing hospice and palliative care (HPC) early in the course of care for patients with life-threatening illness is important for improving patient quality of life. However, little literature exists for factors affecting to the intention to use early palliative care (EPC) of general population. OBJECTIVES This study aimed to identify the sources of information about HPC, investigate whether they affect intention to use HPC and EPC, and examine the relationship between the components of a good death and the intention to use HPC and EPC. METHODS A stratified nationwide cross-sectional survey including 1500 participants, 20-74 years old, was conducted to investigate their intentions to use HPC and EPC, available information sources, and perceived components of a good death. RESULTS The main sources of information about HPC were television and radio. Information acquired from health professionals was positively associated with the intention to use EPC. Although regarding a good relationship with family as a component of a good death was related to low intention to use EPC, being able to trust medical staff, being involved in decisions about care, and being respected as an individual were associated with high intention to use EPC. CONCLUSION Information from health care providers and public awareness through education and publicity efforts are necessary to inform the public about the benefits of EPC. Furthermore, it is essential that medical staff cultivate the skills necessary to secure public trust and provide care that respects patients until the end of their lives.
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Affiliation(s)
- Su Yeon Kye
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jinyoung Choi
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Department of Hospice Palliative Service, National Cancer Center, Goyang, Korea
| | - So Jung Park
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - In Gyu Song
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jung Nam
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
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Ryan S, Wong J, Chow R, Zimmermann C. Evolving Definitions of Palliative Care: Upstream Migration or Confusion? Curr Treat Options Oncol 2020; 21:20. [DOI: 10.1007/s11864-020-0716-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yoo SH, Kim M, Yun YH, Keam B, Kim YA, Kim YJ, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Lee SN, Kim SY, Kang EJ, Do YR, Choi YS, Jung KH. Attitudes toward early palliative care in cancer patients and caregivers: a Korean nationwide survey. Cancer Med 2018; 7:1784-1793. [PMID: 29577624 PMCID: PMC5943547 DOI: 10.1002/cam4.1441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/15/2022] Open
Abstract
Integrated early palliative care (EPC) improves quality of life and reduces psychological distress in adult patients with cancer and caregivers, but attitudes toward EPC have been poorly studied. We aimed to investigate attitudes toward EPC in a nationwide survey of patients with cancer and caregivers. From July to October 2016, we administered nationwide questionnaires examining attitudes toward EPC in patients with cancer (n = 1001) and their families (n = 1006) from 12 Korean hospitals. When an individual considered EPC unnecessary, the reasons were collected and analyzed. Factors associated with perception of EPC were examined. A majority of patients (84.5%) and caregivers (89.5%) had positive attitudes toward EPC. The most common reasons for deeming EPC unnecessary were that EPC may be an obstacle to cancer treatment (patients: 37%; caregivers: 23%; respectively) or that they were not sure if EPC is beneficial (patients: 21%; caregivers: 24%; respectively). Financial burden as a reason was more evident in caregivers (23%) than in patients (17%). Male gender, age <50, early stage, intensive care unit admission, and not believing that dying people should prepare to practice charity were associated with patients’ negative attitudes. In caregivers, opposition to EPC was associated with not thinking death should be feared, not thinking people should be remembered, and lower educational level. Our findings showed that significant numbers of patients with advanced cancer and family caregivers showed positive attitudes toward EPC. However, more than 10% of participants did not consider EPC necessary. Physicians’ communication with patients and caregivers and financial support could help overcome the barriers of EPC.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ae Kim
- Cancer Survivorship Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun-Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, Korea
| | - Eun-Kee Song
- Division of Hematology/Oncology, Chonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Postgraduate Medical School, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Si-Young Kim
- Departments of Medical Oncology and Hematology, Kyung Hee University Hospital, Seoul, Korea
| | - Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Rok Do
- Departments of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yoon Seok Choi
- Departments of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Departments of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
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Chou HC, Huang HL, Chen CY, Wang CL, Shu CC, Hsu NC, Lin YF, Chen JS, Sheng WH. Receipt of Vasopressors Is Positively Associated With the Length of the Actively Dying Process in Hospitalization. Am J Hosp Palliat Care 2018; 35:1043-1049. [PMID: 29378423 DOI: 10.1177/1049909117754040] [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: 12/20/2022] Open
Abstract
BACKGROUND End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process. RESULTS In all, 745 participants, 10.01% of all admitted patients, were analyzed. Of them, 225 patients were RV group, and the remaining 520 were NRV group. Age and gender were comparable in the 2 groups. The use of vasopressors was associated with an admission diagnosis of sepsis and absence of Do-Not-Resuscitate consent and parenteral use of morphine. In multivariable analysis, a high Barthel index score, the absence of cancer and cardiopulmonary resuscitation (CPR), and no receipt of vasopressors were independent factors for LOS. For the length of the actively dying process, a longer duration of inotropic agent, the receipt of vasopressors, and the absence of CPR were independent factors. CONCLUSION In-hospital mortality is not uncommon during hospitalization in a general ward. The length of the actively dying process is extended by the use of vasopressors. Further prospective study is required for cautious evaluation of the pros and cons of using vasopressors at the end of life during hospitalization.
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Affiliation(s)
- Hsiao-Chen Chou
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Liang Huang
- 2 Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiang-Yi Chen
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chuan-Lan Wang
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nin-Chieh Hsu
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Feng Lin
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- 4 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Lee J, Cagle JG. Factors Associated With Opinions About Hospice Among Older Adults: Race, Familiarity With Hospice, and Attitudes Matter. J Palliat Care 2017; 32:101-107. [PMID: 29084485 DOI: 10.1177/0825859717738441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attitudes and opinions about end-of-life care among older adults are understudied. Using survey data from the American Association of Retired Persons (AARP) membership in Florida (N = 2714), this study identified predictors of opinions about hospice (OAH) among older adults. Relationships between race/ethnicity and attitudes were also examined. Results showed race of the respondent was the strongest predictor of one's OAH. Predictors of positive opinions of hospice included being of Caucasian race, non-Hispanic ethnicity, better health, greater familiarity with hospice, a high importance of pain control, the importance of fulfilling personal goals, a desire to have health-care professionals involved in one's care, and having engaged in advance care planning. These findings suggest a need for greater attention to culture-based elements in future research and practice.
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Affiliation(s)
- Joonyup Lee
- 1 School of Social Work, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- 1 School of Social Work, University of Maryland, Baltimore, MD, USA
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Yoo SH, Keam B, Kim M, Kim TM, Kim DW, Heo DS. The Effect of Hospice Consultation on Aggressive Treatment of Lung Cancer. Cancer Res Treat 2017; 50:720-728. [PMID: 28707460 PMCID: PMC6056966 DOI: 10.4143/crt.2017.169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose The aims of this study were to investigate trends of aggressive treatment of non-small cell lung cancer (NSCLC) patients at the end-of-life (EOL) during the recent 5 years and examine the relationship between hospice consultation (HC) and aggressive care. Materials and Methods The medical records of 789 patients with stage IIIB-IV NSCLC at Seoul National University Hospital (SNUH) who received palliative chemotherapy and died from 2010 to 2014 were retrospectively reviewed. Indicators of aggressive treatment were evaluated, and the association of HC with these indicators was analyzed. Results During the last 5 years, the frequency of HC increased from 26.7% to 43.6%. The time interval from last chemotherapy to death increased, and the proportion of patients who received palliative chemotherapy, visited an emergency room, were admitted to intensive care unit, during the last month of life, and died in SNUH significantly decreased over time. Referral to HC was significantly associated with lower intensive care unit admission rates, lower out-of-hospital death rates, and less use of the chemotherapy within 1 month prior to death. Overall survival did not differ by HC. Conclusion The pattern of cancer care nearthe EOL has become less aggressivewhen HCwas provided. The positive association of HCwith better EOL care suggests that providing HC at the optimal time might help to avoid futile aggressive treatment.
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Affiliation(s)
- Shin Hye Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Miso Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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Pan HH, Wu LF, Hung YC, Chu CM, Wang KY. Long-Term Effectiveness of Two Educational Methods on Knowledge, Attitude, and Practice Toward Palliative Care Consultation Services Among Nursing Staff: A Longitudinal Follow-Up Study. Clin Nurs Res 2017; 27:483-496. [PMID: 29228811 DOI: 10.1177/1054773817692082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This experimental study investigated long-term effectiveness of two educational methods on knowledge, attitude, and practice (KAP) about palliative care consultation services (PCCS) among nurses, recruited from a medical center located in Northern Taiwan in 2015, using a stratified cluster sampling method, with 88 participants in multimedia (experimental) and 92 in traditional paper education (control) group. Data were collected using KAP-PCCS questionnaire before education, immediately after, and 3rd and 6th month after education. Results showed that both K-PCCSI and P-PCCSI significantly increased immediately after, and at the 3rd month after education for the experimental group; the K-PCCSI remained significantly higher for the experimental group at the 6th month. The highest increase in scores for both K-PCCSI and P-PCCSI was observed at the 3rd month. There was no significant change in A-PCCS in both groups after follow-up periods, when compared before education. Therefore, using multimedia every 3 months to continue strengthening their knowledge may increase the referrals of terminal patients to PCCS.
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Affiliation(s)
| | - Li-Fen Wu
- 1 National Defense Medical Center, Taipei City, Taiwan.,2 Tri-Service General Hospital, Taipei City, Taiwan
| | - Yu-Chun Hung
- 1 National Defense Medical Center, Taipei City, Taiwan.,2 Tri-Service General Hospital, Taipei City, Taiwan
| | - Chi-Ming Chu
- 1 National Defense Medical Center, Taipei City, Taiwan
| | - Kwua-Yun Wang
- 1 National Defense Medical Center, Taipei City, Taiwan.,3 Taipei Veterans General Hospital, Taipei City, Taiwan.,4 National Yang-Ming University, Taipei City, Taiwan
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13
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Tan WL, Zhang CY. Effect of pathway intervention in agonal patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2017; 25:383-387. [DOI: 10.11569/wcjd.v25.i4.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the effect of pathway intervention in agonal patients with gastric cancer.
METHODS Ninety-six agonal patients with gastric cancer treated from June 2013 to June 2016 at our hospital were randomly divided into either a control group or an observation group, with 48 cases in each group. The control group received conventional palliative intervention, and the observation group was given pathway intervention. Symptom control, nursing quality score, survival time, and Hamilton Depression Scale (HAMD) score were compared between the two groups.
RESULTS The control of dyspnea, pain, nausea and vomiting in the observation group was significantly better than that in the control group (P < 0.05). The difference in survival time between the two groups was not statistically significant (P > 0.05). Nursing quality score was significantly higher in the observation group than in the control group (P < 0.05). HAMD score before intervention did not differ significantly between the two groups (P > 0.05), but was significantly lower in the observation group than in the control group after 4 wk of intervention (P < 0.05).
CONCLUSION Pathway intervention in agonal gastric cancer patients can significantly improve clinical symptoms, depression, and quality of life.
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Nahapetyan L, Orpinas P, Glass A, Song X. Planning Ahead: Using the Theory of Planned Behavior to Predict Older Adults’ Intentions to Use Hospice if Faced With Terminal Illness. J Appl Gerontol 2017; 38:572-591. [DOI: 10.1177/0733464817690678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Hospice is underutilized in the United States, and many patients enroll for short periods of times. The purpose of this cross-sectional study was to identify significant predictors of intentions to use hospice in community-dwelling older adults. The Theory of Planned Behavior informed the selection of predictors. Data were collected from 146 White older adults ( M age = 69.5; 69% females). Multiple linear regression analyses showed that higher hospice knowledge, normative beliefs that support hospice utilization, higher perceived control to use hospice, and preferences for end-of-life care that favor comfort and quality of life over living as long as possible were significant predictors of intentions to use hospice. In spite of being a sample of mostly highly educated older adults, almost half did not know about funding for hospice. These results provide better understanding of where to focus interventions to educate older adults about hospice, ideally in advance of a crisis.
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Affiliation(s)
| | | | - Anne Glass
- University of North Carolina Wilmington, USA
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16
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Abstract
PURPOSE OF REVIEW Patients with progressive chronic kidney disease (CKD) have high morbidity, mortality, and symptom burden. Cardiovascular disease (CVD) and congestive heart failure (CHF) often contribute to these burdens and should be considered when providing recommendations for care. This review aims to summarize recent literature relevant to the provision of palliative and end-of-life care for patients with progressive CKD and specifically highlights issues relevant to those with CVD and CHF. RECENT FINDINGS Dialysis may not benefit older, frail patients with progressive CKD, especially those with other comorbidities. Patients managed conservatively (i.e., without dialysis) may live as long as patients who elect to start dialysis, with better preservation of function and quality of life and with fewer acute care admissions. Decisions regarding dialysis initiation should be made on an individual basis, keeping in mind each patient's goals, comorbidities, and underlying functional status. Conservative management of progressive kidney disease is frequently not offered but is likely to benefit many older, frail patients with comorbidities such as CHF and CVD. SUMMARY A palliative approach to the care of many patients with progressive CKD is essential to ensuring they receive appropriate quality care.
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Mahar AL, Coburn NG, Viola R, Johnson AP. Predictors of hospital stay and home care services use: a population-based, retrospective cohort study in stage IV gastric cancer. Palliat Med 2015; 29:147-56. [PMID: 25344156 DOI: 10.1177/0269216314554325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Home care services use has been proposed as a means of reducing costs in palliative care by decreasing hospital stay without impacting quality of clinical care; however, little is known about utilization of these services in the time following a terminal cancer diagnosis. AIM To examine disease, patient and healthcare system predictors of hospital stay, and home care services use in metastatic gastric cancer patients. DESIGN This is a population-based, retrospective cohort study. Chart review and administrative data were linked, using a 26-month time horizon to collect health services data. PARTICIPANTS All patients diagnosed with metastatic gastric cancer in the province of Ontario between 2005 and 2008 were included in the study (n = 1433). RESULTS Age, comorbidity, tumor location, and burden of metastatic disease were identified as predictors of hospital stay and receipt of home care services. Individuals who received home care services spent fewer days in hospital than individuals who did not (relative risk: 0.44; 95% confidence interval: 0.38-0.51). Patients who interacted with a high-volume oncology specialist had shorter cumulative hospital stay (relative risk: 0.62; 95% confidence interval: 0.54-0.71) and were less likely to receive home care services (relative risk: 0.80; 95% confidence interval: 0.72-0.88) than those who did not. CONCLUSION Examining how differences in hospital stay and home care services use impact clinical outcomes and how policies may reduce costs to the healthcare system is necessary.
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Affiliation(s)
- Alyson L Mahar
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Natalie G Coburn
- Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Raymond Viola
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ana P Johnson
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Centre for Health Services and Policy Research, Queen's University, Kingston, ON, Canada
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