The effect of Palliative Daycare on Hope: A comparison of Daycare Patients with Two Control Groups

Background: Despite expansion in palliative daycare services, research has not demonstrated an improvement in patient outcomes. This study aimed to determine the effect of palliative daycare on hope. Methods: This was a prospective cohort study that compared three groups of patients: a daycare group and two control groups, one recruited before daycare opened and a matched comparison group. Patients were interviewed at baseline and at two follow-ups using the Herth Hope Index. Results: In all, 22 daycare patients completed a baseline interview (T1); 12 a second (T2); and 9 a third (T3). Corresponding numbers were: before group (56, 34, 24) and matched group (49, 29, 19). An independent samples t-test confirmed a significant difference between the groups from T1 to T2 (mean difference=3.20, p=0.007), with the daycare group experiencing an increase in hope not seen in the other groups. However, this was not maintained. Conclusion: Daycare may effect an initial improvement in hope. The study suffered from attrition and the sample was small. Further robust evaluation of daycare is needed.

Esperanza en Pacientes Oncológicos Paliativos hacia una revisión sistemática

Objetivo. Revisión sobre el término esperanza. Método. Estudio sistemático, en el que se han seleccionado 31 artículos con población oncológica adulta, en estadio terminal, de edades entre 20 a 88 años, de ambos géneros. Resultado. La esperanza, es inherente para la vida del ser humano, es una expectativa del futuro, dinámica, cambiante, fluctuante, medible y multifacética; presenta dos connotaciones como verbo y como sustantivo. La esperanza se puede mantener y fomentar mediante estrategias personales del paciente, del entorno social y de los profesionales de la salud; además, existen herramientas, técnicas, programas y psicoterapias que facilitan dichos resultados. Conclusión. La esperanza se puede fomentar, mantener y fortalecer y es fundamental para esta etapa de enfermedad. No existe un protocolo de intervención específico, lo principal es escuchar al paciente.

Advance care planning in COPD

Chronic obstructive pulmonary disease (COPD) in advanced stages runs an unpredictable downward course with increasingly frequent, ultimately fatal exacerbations. Worldwide financial and human costs are huge. Responsibility for initiating advance care planning in COPD has usually fallen to the physicians. The tendency has been to avoid this aspect of care, which can result in inadequate, rushed, reactive, crisis decision-making in the form of a “code status” discussion. In this article, I review the relevant literature and report findings from a qualitative study designed within my doctoral program to explore the question, “What is required for meaningful and effective advance care planning in the context of advanced COPD?” I describe the “collaborative care” approach to advance care planning I used with eight patients and carers living with advanced COPD. Along with a skilled clinician facilitator, user-friendly education elements, and attention to readiness, unique aspects of the approach included a focus on caring, engaging hope, facilitator reflective praxis, and contextual sensitivity. This approach has significant potential for enhancing decision making and goal setting, efficiency of resource utilization, and satisfaction with outcomes. Done well, it may reclaim the care element in advance care planning as it addresses barriers cited by physicians and patients/families.