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Renard O, Couillet A, Bourcelot S, Chvetzoff G. Vécu chez les oncologues médicaux de l’annonce du transfert en unité de soins palliatifs à l’un de leurs patients. Bull Cancer 2022; 109:938-947. [DOI: 10.1016/j.bulcan.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 10/17/2022]
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Shah R, Georgousopoulou EN, Al-Rubaie Z, Sulistio M, Tee H, Melia A, Michael N. Impact of ambulatory palliative care on symptoms and service outcomes in cancer patients: a retrospective cohort study. BMC Palliat Care 2022; 21:28. [PMID: 35241067 PMCID: PMC8896341 DOI: 10.1186/s12904-022-00924-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of palliative care into routine cancer care has allowed for improved symptom control, relationship building and goal setting for patients and families. This study aimed to assess the efficacy of an ambulatory palliative care clinic on improving symptom burden and service outcomes for patients with cancer. METHODS A retrospective review of data of cancer patients who attended an ambulatory care clinic and completed the Symptom Assessment Scale between January 2015 and December 2019. We classified moderate to severe symptoms as clinically significant. Clinically meaningful improvement in symptoms (excluding pain) was defined by a ≥ 1-point reduction from baseline and pain treatment response was defined as a ≥ 2-point or ≥ 30% reduction from baseline. RESULTS A total of 249 patients met the inclusion criteria. The most common cancer diagnosis was gastrointestinal (32%) and the median time between the initial and follow-up clinic was 4 weeks. The prevalence of clinically significant symptoms at baseline varied from 28% for nausea to 88% for fatigue, with 23% of the cohort requiring acute admission due to unstable physical/psychosocial symptoms. There was significant improvement noted in sleep (p < 0.001), pain (p = 0.002), wellbeing (p < 0.001), and overall symptom composite scores (p = 0.028). Despite 18-28% of patients achieving clinically meaningful symptom improvement, 18-66.3% of those with moderate to severe symptoms at baseline continued to have clinically significant symptoms on follow-up. A third of patients had opioid and/or adjuvant analgesic initiated/titrated, with 39% educated on pain management. Goals of care (31%), insight (28%) and psychosocial/existential issues (27%) were commonly explored. CONCLUSIONS This study highlights the burden of symptoms in a cohort of ambulatory palliative care patients and the opportunity such services can provide for education, psychosocial care and future planning. Additionally routine screening of cohorts of oncology patients using validated scales may identify patients who would benefit from early ambulatory palliative care.
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Affiliation(s)
- Rajvi Shah
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia.
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Ekavi N Georgousopoulou
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Ziad Al-Rubaie
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Hoong Tee
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 154 Wattletree Road, Malvern, VIC, 3144, Australia
- School of Medicine, Sydney Campus, University of Notre Dame Australia, Sydney, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Schichtel M, Wee B, Perera R, Onakpoya I, Albury C. Effect of Behavior Change Techniques Targeting Clinicians to Improve Advance Care Planning in Heart Failure: A Systematic Review and Meta-Analysis. Ann Behav Med 2021; 55:383-398. [PMID: 32926081 DOI: 10.1093/abm/kaaa075] [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: 11/12/2022] Open
Abstract
BACKGROUND National and international guidelines recommend advance care planning (ACP) for patients with heart failure. But clinicians seem hesitant to engage with ACP. PURPOSE Our aim was to identify behavioral interventions with the greatest potential to engage clinicians with ACP in heart failure. METHODS A systematic review and meta-analysis. We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index, and PsycINFO for randomized controlled trials (RCTs) from inception to August 2018. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (Grading of Recommendation Assessment, Development, and Evaluation), and intervention synergy according to the behavior change wheel and behavior change techniques (BCTs). Odds ratios (ORs) were calculated for pooled effects. RESULTS Of 14,483 articles screened, we assessed the full text of 131 studies. Thirteen RCTs including 3,709 participants met all of the inclusion criteria. The BCTs of prompts/cues (OR: 4.18; 95% confidence interval [CI]: 2.03-8.59), credible source (OR: 3.24; 95% CI: 1.44-7.28), goal setting (outcome; OR: 2.67; 95% CI: 1.56-4.57), behavioral practice/rehearsal (OR: 2.64; 95% CI: 1.50-4.67), instruction on behavior performance (OR: 2.49; 95% CI: 1.63-3.79), goal setting (behavior; OR: 2.12; 95% CI: 1.57-2.87), and information about consequences (OR: 2.06; 95% CI: 1.40-3.05) showed statistically significant effects to engage clinicians with ACP. CONCLUSION Certain BCTs seem to improve clinicians' practice with ACP in heart failure and merit consideration for implementation into routine clinical practice.
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Affiliation(s)
- Markus Schichtel
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Biomedical Campus, Cambridge, UK
| | - Bee Wee
- Oxford Centre for Education and Research in Palliative Care, Oxford University Hospital Trust, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Murimi MW, Kanyi MG, Mbogori TN, Amin MR, Rana ZH, Nguyen B, Moyeda-Carabaza AF. Voices and perspectives of rural Hispanic households on food insecurity in west Texas: a qualitative study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019. [DOI: 10.1080/19320248.2018.1434105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Mary W. Murimi
- College of Human Sciences, Texas Tech University, Lubbock, Texas, United States
| | - Michael G. Kanyi
- Imperial Valley College, Business & Agriculture Department, United States
| | - Teresia N. Mbogori
- Ball State University, Department of Nutrition and Health Sciences, United States
| | - Md Ruhul Amin
- College of Human Sciences, Texas Tech University, Lubbock, Texas, United States
| | - Ziaul H. Rana
- College of Human Sciences, Texas Tech University, Lubbock, Texas, United States
| | - Bong Nguyen
- College of Human Sciences, Texas Tech University, Lubbock, Texas, United States
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Michael N, Beale G, O'Callaghan C, Melia A, DeSilva W, Costa D, Kissane D, Shapiro J, Hiscock R. Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, single-center observational study. BMC Palliat Care 2019; 18:13. [PMID: 30691417 PMCID: PMC6350289 DOI: 10.1186/s12904-019-0399-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/21/2019] [Indexed: 01/05/2023] Open
Abstract
Background Pancreatic cancer is noted for its late presentation at diagnosis, limited prognosis and physical and psychosocial symptom burden. This study examined associations between timing of palliative care referral (PCR) and aggressive cancer care received by pancreatic cancer patients in the last 30 days of life through a single health service. Method A retrospective cohort analysis of end-of-life (EOL) care outcomes of patients with pancreatic cancer who died between 2012 and 2016. Key indicators of aggressive cancer care in the last 30 days of life used were: ≥1 emergency department (ED) presentations, acute inpatient/intensive care unit (ICU) admission, and chemotherapy use. We examined time from PCR to death and place of death. Early and late PCR were defined as > 90 and ≤ 90 days before death respectively. Results Out of the 278 eligible deaths, 187 (67.3%) were categorized as receiving a late PCR and 91 (32.7%) an early PCR. The median time between referral and death was 48 days. Compared to those receiving early PCR, those with late PCR had: 18.1% (95% CI 6.8–29.4%) more ED presentations; 12.5% (95% CI 1.7–24.8%) more acute hospital admissions; with no differences in ICU admissions. Pain and complications of cancer accounted for the majority of overall ED presentations. Of the 166 patients who received chemotherapy within 30 days of death, 23 (24.5%) had a late PCR and 12 (16.7%) an early PCR, with no association of PCR status either unadjusted or adjusted for age or gender. The majority of patients (55.8%) died at the inpatient palliative care unit. Conclusion Our findings reaffirm the benefits of early PCR for pancreatic cancer patients to avoid inappropriate care toward the EOL. We suggest that in modern cancer care, there can sometimes be a need to reconsider the use of the term ‘aggressive cancer care’ at the EOL when the care is appropriately based on an individual patient’s presenting physical and psychosocial needs. Pancreatic cancer patients warrant early PCR but the debate must thus continue as to how we best achieve and benchmark outcomes that are compatible with patient and family needs and healthcare priorities.
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Affiliation(s)
- Natasha Michael
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia. .,School of Medicine, University of Notre Dame, Sydney, NSW, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Greta Beale
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia.,Departments of Psychosocial Cancer Care and Medicine, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia.,Institute for Ethics and Society, University of Notre Dame, Sydney, NSW, Australia
| | - Adelaide Melia
- Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia
| | - William DeSilva
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Daniel Costa
- Pain Management Research Institute, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Kissane
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, VIC, Australia
| | - Jeremy Shapiro
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
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The impact of early palliative care on the quality of care during the last days of life: what does the evidence say? Curr Opin Support Palliat Care 2018; 10:310-315. [PMID: 27635766 DOI: 10.1097/spc.0000000000000240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to critically appraise the existing evidence on 'early palliative care' (EPC), discuss its relationship with advance care planning, and to reflect on the impact of EPC on the quality of care provided during the last days of life. RECENT FINDINGS There are indicators that EPC may help to avoid aggressive treatment, shorten hospital stay, improve overall quality of life, and to see more frequently dying and death at the preferred place of care. SUMMARY The evidence from randomized controlled trials supports the integration of palliative care early in the disease trajectory. However, in terms of outcomes and quality indicators for care in the last days of life, evidence is still lacking. Predominantly, when it comes to the outcomes which may be more difficult to assess, such as spiritual aspects, or the social network, for which more comprehensive information is needed. These outcomes should not be neglected in palliative care studies, particularly when they can provide meaningful information about patient and family adjustment, and focus on psychosocial aspects rather than physical symptom control.
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Collins A, McLachlan SA, Philip J. Initial perceptions of palliative care: An exploratory qualitative study of patients with advanced cancer and their family caregivers. Palliat Med 2017; 31:825-832. [PMID: 28367679 DOI: 10.1177/0269216317696420] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Despite evidence for early integration of palliative care for people with advanced cancer and their families, patterns of late engagement continue. Prior research has focused on health professionals' attitudes to palliative care with few studies exploring the views of patients and their carers. AIM To explore initial perceptions of palliative care when this is first raised with patients with advanced cancer and their families in Australian settings. DESIGN Cross-sectional, prospective, exploratory qualitative design, involving narrative-style interviews and underpinned by an interpretative phenomenological framework. SETTING/PARTICIPANTS Purposively sampled, English-speaking, adult patients with advanced cancer ( n = 30) and their nominated family caregivers ( n = 25) recruited from cancer services at a tertiary metropolitan hospital in Melbourne, Victoria, Australia. RESULTS Three major themes evolved which represent the common initial perceptions of palliative care held by patients with advanced cancer and their carers when this concept is first raised: (1) diminished care, (2) diminished possibility and (3) diminished choice. Palliative care was negatively associated with a system of diminished care which is seen as a 'lesser' treatment alternative, diminished possibilities for hope and achievement of ambitions previously centred upon cure and diminished choices for the circumstances of one's care given all other options have expired. CONCLUSION While there is an increasing move towards early integration of palliative care, this study suggests that patient and caregiver understandings have not equally progressed. A targeted public health campaign is warranted to disentangle understandings of palliative care as the 'institutional death' and to reframe community rhetoric surrounding palliative care from that of disempowered dying to messages of choice, accomplishment and possibility.
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Affiliation(s)
- Anna Collins
- 1 Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Sue-Anne McLachlan
- 2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,3 Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Jennifer Philip
- 1 Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,2 Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,4 Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
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Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals. Palliat Support Care 2017; 16:286-297. [PMID: 28434435 DOI: 10.1017/s1478951517000244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjective:A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population. METHOD A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL-90-R Symptoms Inventory. RESULTS There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI-HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15-30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it. SIGNIFICANCE OF RESULTS A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.
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Costello J. Research roundup. Int J Palliat Nurs 2016; 22:360-1. [PMID: 27444165 DOI: 10.12968/ijpn.2016.22.7.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- John Costello
- Senior Lecturer, University of Manchester School of Nursing, Midwifery and Social Work
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Affiliation(s)
- Jeroen Hasselaar
- Department of Anesthesiology, Pain, Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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