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Yamada M, Uchida M, Hada M, Wakabayashi H, Inma D, Ariyoshi S, Kamimura H, Haraguchi T. Pharmacists' Behavioral Changes after Attending a Multi-Prefectural Palliative Care Education Program. PHARMACY 2024; 12:87. [PMID: 38921963 PMCID: PMC11207959 DOI: 10.3390/pharmacy12030087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
Central to the pharmacist's role in palliative care is symptom management through direct participation in patient care and the provision of optimal pharmacotherapy to support patient outcomes. Consequently, palliative care requires extensive knowledge and action for patients with cancer. Therefore, this study aimed to evaluate how pharmacists' behavior changed after attending a palliative care educational program. We conducted a web-based questionnaire survey examining the behavior of pharmacists regarding palliative care before participating in the program, two months after participating in the program, and eight months after participating in the program to determine their behavior and changes over time. For all questions, scores were higher at two and eight months after attending the program than before attending the program (p < 0.05). In addition, no significant difference was observed between two and eight months after attending the program for any question (p = 0.504-1.000). The knowledge gained from the educational program was used to repeatedly intervene with patients with cancer in order to address the various symptoms they experienced and maintain their behavior. The proven effectiveness of this program serves as a stepping stone for nationwide rollout across Japan's 47 prefectures.
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Affiliation(s)
- Masahiro Yamada
- Department of Pharmacy, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita, Kitakyushu 802-0077, Japan;
| | - Mayako Uchida
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyotanabe 610-0395, Japan;
| | - Masao Hada
- Department of Pharmacy, Japan Community Health care Organization Nankai Medical Center, 7-8, Tokiwanishimachi, Saiki 876-0857, Japan;
| | - Haruka Wakabayashi
- Department of Education and Research Center for Pharmacy Practice, Faculty of Pharmaceutical Sciences, Doshisha Women’s College of Liberal Arts, Kyotanabe 610-0395, Japan;
| | - Daigo Inma
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
| | - Shunji Ariyoshi
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
| | - Hidetoshi Kamimura
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
- Department of Pharmacy, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan, Fukuoka 814-0180, Japan
| | - Tohru Haraguchi
- A Public Interest Incorporated Foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata, Fukuoka 812-0018, Japan; (D.I.); (S.A.); (H.K.); (T.H.)
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Henshaw AM, Winstead SR. Building Bridges in Palliative Rehabilitation: An Evidence-Based Toolkit to Promote Collaboration. Am J Hosp Palliat Care 2024; 41:601-609. [PMID: 37462170 DOI: 10.1177/10499091231184621] [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] [Indexed: 04/21/2024] Open
Abstract
Background: Palliative care and rehabilitation professionals caring for seriously ill people and their families face barriers to effective, timely collaboration. Barriers such as ineffective communication processes, role misunderstanding across professions, and resource limitations can lead to underutilization of rehabilitation services for this vulnerable population. Objectives: To create practical connections between palliative care and rehabilitation professionals and to provide tools and strategies for teams to develop the core competencies (role clarity, communication, teamwork, and shared values) necessary to provide coordinated, timely, effective care to people living with serious illness. Design: With Interprofessional Education Collaborative (IPEC) Core Competencies1 as a framework for interprofessional collaborative practice, a quality improvement project was conducted at a large academic medical center. The 5-phase project included literature review, expert interviews, identification of barriers and facilitators, development of strategies to mitigate barriers, and pilot testing of select strategies. Results: The PalRehab Toolkit consists of strategies to enhance interprofessional collaborative practice and infuse rehabilitation into palliative care in the acute care setting. Preliminary evaluation of piloted strategies suggests increased communication across professions, improved role clarity, and an increased likelihood of collaboration. Conclusion: Providing educational offerings, establishing efficient communication channels, and infusing rehabilitation concepts into palliative care practices, as outlined in the PalRehab Toolkit, may positively impact interprofessional collaborative practice and improve care delivery for people with serious illness and their families.
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Affiliation(s)
- Ann M Henshaw
- Department of Occupational Therapy, Medstar Georgetown University Hospital, Washington, D.C. USA
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Johnston BM, Miller M, Normand C, Cardona M, May P, Lowney AC. Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale. BMC Palliat Care 2024; 23:46. [PMID: 38374101 PMCID: PMC10877897 DOI: 10.1186/s12904-024-01384-9] [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: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. METHODS We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). RESULTS Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. CONCLUSION Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.
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Affiliation(s)
- Bridget M Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland.
| | - Mary Miller
- Department of Palliative Care, Oxford University Hospitals NHS Foundation Trust, Oxford, England
- Nuffield Department of Medicine, Oxford University, Oxford, England
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Magnolia Cardona
- Faculty of Health and Behavioural Sciences, School of Psychology, The University of Queensland, Brisbane, Australia
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, Australia
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, 3-4 Foster Place, Dublin 2, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, England
| | - Aoife C Lowney
- Department of Palliative Care, Marymount University Hospital and Hospice and Cork University Hospital, Cork, Ireland
- University College Cork, Cork, Ireland
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Bernabeu-Wittel M, Moreno-Gaviño L, Nieto-Martín D, Lanseros-Tenllado J, Sáenz-Santamaría A, Martínez-Pérez O, Aguilera-Gonzalez C, Pereira-Domínguez M, Ollero-Baturone M. Physiotherapy in palliative medicine: patient and caregiver wellness. BMJ Support Palliat Care 2023; 13:e197-e204. [PMID: 33579794 DOI: 10.1136/bmjspcare-2020-002826] [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: 11/29/2020] [Revised: 12/21/2020] [Accepted: 01/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Despite the demonstrated efficacy of physiotherapy in palliative care programmes, there are scarce data of its real-life impact on patients' and caregivers' wellness and stress. Our aim was to assess effectiveness of a 30-day physiotherapy programme in psychological wellness and health-related quality of life (HRQoL) of patients with advanced chronic diseases or cancer and in their caregivers' stress. METHODS Quasiexperimental before-after study applying personalised kinesitherapy, exercise with curative effects, respiratory physiotherapy, therapeutic massages and ergotherapy. Psychological wellness, HRQoL and caregiver's strain outcomes were measured. RESULTS 207 patients (60% men, with a mean age of 73.6±12 years) were included; 129 (62.3%) with advanced cancer, and the remaining 78 with advanced chronic diseases. Psychological wellness (Emotional Stress Detection Tool decreased from 12.4±3 to 11±3; p<0.0001), caregiver's strain (Caregiver Strain Index decreased from 8.5±3.2 to 7.9±3.5; p<0.0001) and HRQoL (WHO-BREF physical health domain increased from 8.3±2.6 to 9.4±2.9; p<0.0001) showed a significant improvement after the physiotherapy programme. Global satisfaction with the physiotherapy intervention was also high (Client Satisfaction Questionnaire-8 of 28.3±3.3 points). CONCLUSIONS A personalised physiotherapy programme incorporated to integral palliative care improved psychological wellness, HRQoL and caregivers' strain of patients with advanced chronic diseases and cancer.
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Affiliation(s)
- Máximo Bernabeu-Wittel
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Department of Medicine, University of Seville, Sevilla, Spain
| | - Lourdes Moreno-Gaviño
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Dolores Nieto-Martín
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ana Sáenz-Santamaría
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Olga Martínez-Pérez
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Manuel Ollero-Baturone
- Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Navarro-Meléndez A, Gimenez MJ, Robledo-Donascimento Y, Río-González A, Lendínez-Mesa A. Physiotherapy applied to palliative care patients: a descriptive practice-based study. BMC Palliat Care 2023; 22:99. [PMID: 37474943 PMCID: PMC10357741 DOI: 10.1186/s12904-023-01188-3] [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: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Over the last few years, the presence of physiotherapists in Palliative Care Units (PCU) has considerably grown based on evidence from studies supporting the use of non-pharmacological measures as part of Palliative Care (PC) treatments. However, more accumulated data are needed to definitively establish its added value. The present study describes the type of patients receiving physiotherapy in a PCU and the benefits obtained in relation to their degree of functional dependence. METHODS An observational, prospective, descriptive, practice-based study was undertaken involving patients admitted to the PCU of Fundación Instituto San José (Madrid, Spain), who according to the PCU´s clinical practice, met the criteria for physiotherapy intervention. Daily clinical practice was unchanged for study reasons. Participants were assessed prior to initiating and at the end of the physiotherapy program using the following standard scales: the Barthel Index, the Functional Ambulation Categories scale, the Palliative Performance Scale, and the Braden scale. A descriptive analysis was performed and scale scores prior to and after treatment were compared using the Wilcoxon signed-rank test. Significance was set at 0.05. RESULTS A total of 63 patients were included (mean age 71.98 ± 12.72; 61.9% males). Fifty-eight patients (92.1%) were oncological patients; of them, 35 (60.3%) had metastases. Prior to treatment, 28 (44.4%) participants had total dependence according to the Barthel index, and 37 (58.7%) were non-functional ambulator according to the FAC scale. At the end of treatment, the number of patients with total dependence decreased to 15 (23.8%) and those non-functional ambulator to 12 (19.0%). CONCLUSIONS Patients who benefited from physical therapy during their admission to our PCU were predominantly males with oncological processes, mainly lung cancer. PC including physiotherapy improved their functionality, independence and skills for activities of daily living in this sample of PCU patients.
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Affiliation(s)
- A Navarro-Meléndez
- Rehabilitation area, Hospital Fundación Instituto San José, Avenida de la Hospitalidad s/n, Madrid, 28054 Spain
- Department of Health Sciences, “San Juan de Dios” School of Nursing and Physical Therapy, Comillas Pontifical University, Avenida San Juan de Dios, 1, Ciempozuelos, 28350 Spain
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - MJ Gimenez
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - Y Robledo-Donascimento
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
- Hospital Universitario del Henares and Centro de Investigación Fisioterapia y Dolor, Avenida de Marie Curie 0, Coslada, 28822 Spain
| | - A Río-González
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, Villaviciosa de Odón, 28670 Spain
| | - A Lendínez-Mesa
- Department of Nursing, Neurology Service. Grupo de Investigación en Cuidados (InveCuid), Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041 Spain
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Kluger BM, Hudson P, Hanson LC, Bužgovà R, Creutzfeldt CJ, Gursahani R, Sumrall M, White C, Oliver DJ, Pantilat SZ, Miyasaki J. Palliative care to support the needs of adults with neurological disease. Lancet Neurol 2023; 22:619-631. [PMID: 37353280 DOI: 10.1016/s1474-4422(23)00129-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/25/2023]
Abstract
Neurological diseases cause physical, psychosocial, and spiritual or existential suffering from the time of their diagnosis. Palliative care focuses on improving quality of life for people with serious illness and their families by addressing this multidimensional suffering. Evidence from clinical trials supports the ability of palliative care to improve patient and caregiver outcomes by the use of outpatient or home-based palliative care interventions for people with motor neuron disease, multiple sclerosis, or Parkinson's disease; inpatient palliative care consultations for people with advanced dementia; telephone-based case management for people with dementia in the community; and nurse-led discussions with decision aids for people with advanced dementia in long-term care. Unfortunately, most people with neurological diseases do not get the support that they need for their palliative care under current standards of healthcare. Improving this situation requires the deployment of routine screening to identify individual palliative care needs, the integration of palliative care approaches into routine neurological care, and collaboration between neurologists and palliative care specialists. Research, education, and advocacy are also needed to raise standards of care.
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Affiliation(s)
- Benzi M Kluger
- University of Rochester Medical Center, Rochester, NY, USA.
| | - Peter Hudson
- The University of Melbourne, Fitzroy, VIC, Australia; St Vincent's Hospital, Melbourne, Fitzroy, VIC, Australia; Vrije Universiteit Brussel, Brussel, Belgium
| | - Laura C Hanson
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Radka Bužgovà
- Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | - Roop Gursahani
- Hinduja Hospital & Medical Research Centre, Mumbai, Maharashtra, India
| | - Malenna Sumrall
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Charles White
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Steven Z Pantilat
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Tanriverdi A, Ozcan Kahraman B, Ergin G, Karadibak D, Savci S. Effect of exercise interventions in adults with cancer receiving palliative care: a systematic review and meta-analysis. Support Care Cancer 2023; 31:205. [PMID: 36882538 DOI: 10.1007/s00520-023-07655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 02/21/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Previous publications showed the effectiveness of exercise in adults with cancer receiving palliative care, but evidence for palliative care research on exercise is lacking. The purpose is to examine the effects of an exercise intervention on exercise capacity, physical function, and patient-reported outcome measures in adults with cancer receiving palliative care. METHODS We searched databases including EMBASE, PubMed, and Web of Science from inception until 2021. We used the Cochrane criteria to assess the risk of bias within studies. Using RevMan, mean difference (MD) and 95% confidence intervals or standardized mean difference (SMD) and 95% confidence intervals were calculated. RESULTS A total of 14 studies and 1034 adults with cancer receiving palliative care are included in this systematic review and meta-analysis. Half of the studies were deemed to have high risk of bias. All of the interventions used aerobic and/or resistance exercises. The results indicated that exercise interventions significantly improved exercise capacity (mean difference: 46.89; 95% confidence interval: 4.51 to 89.26; Z = 2.17; P = 0.03), pain (standardized mean difference: - 0.29; 95% confidence interval: - 0.54 to - 0.03; Z = 2.18; P = 0.03), fatigue (standardized mean difference: - 0.48; 95% confidence interval: - 0.83 to - 0.12; Z = 2.66; P = 0.008), and quality of life (standardized mean difference: 0.23; 95% confidence interval: 0.02 to 0.43; Z = 2.12; P = 0.03). CONCLUSION Exercise training, with aerobic exercise, resistance exercise, or combined aerobic and resistance exercise, helps to maintain or improve exercise capacity, pain, fatigue, and quality of life in adults with cancer receiving palliative care.
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Affiliation(s)
- Aylin Tanriverdi
- Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey. .,Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey.
| | - Buse Ozcan Kahraman
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
| | - Gulbin Ergin
- Department of Physiotherapy and Rehabilitation, İzmir Bakırçay University, İzmir, Turkey
| | - Didem Karadibak
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
| | - Sema Savci
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Mithatpaşa Street No. 1606, 35330, İzmir, Turkey
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Seng AWP, Tham SL. Palliative rehabilitation in end-stage renal failure. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
In end-stage chronic kidney disease (CKD), patients experience disabilities stemming from organ failure. These can be worsened by symptoms and complications of underlying cause(s), and the conditions associated with the CKD. There is a dearth of literature regarding palliative rehabilitation in end-stage CKD. Our case highlights the complex medical and rehabilitative issues that such patients face.
Case presentation
A 64-year-old male had end-stage CKD and declined dialysis. After sustaining a myocardial infarction, he suffered a posterior circulation stroke the following month. Whilst undergoing stroke rehabilitation, his progress was further hampered by symptoms of kidney failure. The patient underwent interdisciplinary rehabilitation for 29 days. Goal-setting was performed with the patient and family to allow contextualization to the patient’s stage of disease, beliefs and environment. Care-giver training was provided to facilitate discharge back home. He demonstrated improvements in physical endurance and function. His Functional Independence Measure score improved from 51 to 82. He outlived his prognosis of 3–6 months and demised 15 months after discharge.
Conclusions
In end-stage CKD without renal replacement therapy, rehabilitation and palliative care efforts align to enhance quality of life, in the face of unlikely cure. While palliative care provides symptom management and supportive care, rehabilitation safeguards physical endurance and ability. It is in the hope of doing so, independence and thence, self-esteem, can be maintained. Future research should explore the benefits of palliative rehabilitation in renal failure.
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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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Ní Chéileachair FN, Johnston BM, Payne C, Cahill F, Mannion L, McGirr L, Ryan K. Protocol for an exploratory, longitudinal single case study of a novel palliative care rehabilitative service. HRB Open Res 2022; 4:131. [PMID: 35118229 PMCID: PMC8790707 DOI: 10.12688/hrbopenres.13461.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Early access to rehabilitation can improve quality of life for those with life-limiting illnesses and is highlighted as a core component of the Adult Palliative Care Services Model of Care for Ireland. Despite this, palliative rehabilitation remains under-utilised and under-developed. In 2020, the Sláintecare Integration Fund provided opportunity to pilot a novel rehabilitative palliative care service, “Palliat Rehab”. This protocol proposes a case study, which aims to advance understanding of the form, content, and delivery of the pilot service. Methods: A prospective, longitudinal, mixed-methods, case study design will be used to describe the service and to explore the experiences of patients, informal carers and clinicians. Additionally, data collection instruments will be tested and the utility of outcome measures will be examined. Data will be collected from documentary, survey, and interview sources. Quantitative data will be analysed using descriptive statistics, including chi-square tests for categorical variables, Mann-Whitney U tests for ordinal data, and t-tests/ ANOVA for continuous data. Qualitative data will be analysed using thematic analysis. Conclusions: New pathways are required to advance service provision to ensure that patients receive the ‘right care, in the right place, at the right time’. This protocol outlines a case study which will aim to develop current understanding of the implementation and delivery of a novel rehabilitative palliative care service in Ireland and will consider its potential contribution to the achievement of Sláintecare goals. Investigating the service within its environmental context will lead to a better understanding of ‘how’ and ‘why’ things happen. Findings will be used to inform efforts to further develop and tailor the intervention.
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Affiliation(s)
| | - Bridget M. Johnston
- Centre for Health and Policy Management, Trinity College Dublin, Dublin, Ireland
| | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | | | - Lisa Mannion
- Department of Palliative Care, Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
| | | | - Karen Ryan
- Department of Palliative Care, Mater Misericordiae University Hospital, Dublin, Dublin, Ireland
- St. Francis Hospice, Dublin, Ireland
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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Brooks FA, Keeney T, Ritchie C, Tolchin DW. Rehabilitation for Symptom Management for Patients with Cancer at the End of Life: Current Evidence and Barriers to Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Yeh JC, Lewis R, Mehta AK, Asher A, Raj VS, Engle JP. Palliative Care and Rehabilitative Medicine: A Call for Greater Collaboration. J Palliat Med 2021; 24:1422-1423. [PMID: 34596466 DOI: 10.1089/jpm.2021.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jonathan C Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Lewis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Arash Asher
- Patient and Family Support Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vishwa S Raj
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina, USA.,Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jessica P Engle
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Zemel RA. Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients. Am J Hosp Palliat Care 2021; 39:847-855. [PMID: 34510917 DOI: 10.1177/10499091211040436] [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: 11/17/2022] Open
Abstract
As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients' dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.
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Affiliation(s)
- Rachel A Zemel
- MedStar Georgetown University Hospital, Brookeville, MD, USA
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Soones T, Ombres R, Escalante C. An update on cancer-related fatigue in older adults: A narrative review. J Geriatr Oncol 2021; 13:125-131. [PMID: 34353750 DOI: 10.1016/j.jgo.2021.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/17/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022]
Abstract
Up to 70% of older adults report fatigue after a cancer diagnosis. For many of these patients, cancer-related fatigue (CRF) persists for years after cancer treatment and is associated with significant disability. Despite this, little has been written on the diagnosis and management of CRF in older adults. To address this gap, we performed a narrative review of the literature on CRF in older adults and used literature from the general population when evidence was lacking to provide guidance to clinical providers on how to tailor care to this population. We recommend evidence-based options for evaluating CRF and address their limitations in the assessment of older adults. We also provide guidance and a treatment algorithm on evaluating CRF using the Comprehensive Geriatrics Assessment. Lastly, we present evidence for the use of non-pharmacologic and pharmacologic therapies in the management of CRF in older adults.
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Affiliation(s)
- Tacara Soones
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, TX 77030, USA.
| | - Rachel Ombres
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, TX 77030, USA.
| | - Carmen Escalante
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1465, Houston, TX 77030, USA.
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Yamada M, Uchida M, Hada M, Inma D, Ariyoshi S, Kamimura H, Haraguchi T. Evaluation of changes in pharmacist behaviors following a systematic education program on palliative care in cancer. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:417-422. [PMID: 33715805 DOI: 10.1016/j.cptl.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE Attitudes, experience, and knowledge of healthcare professionals guide the care they provide and are particularly important factors affecting the quality of palliative care. Palliative care education for pharmacists is crucial for improving quality of care and effective participation on the palliative care team. EDUCATIONAL ACTIVITY AND SETTING We previously developed and reported a systematic and multifaceted pharmacist education program for cancer-related palliative care. We compared 12 behavioral changes immediately (August 2017) and two years after (October 2019) participation in this systematic education program (SEP) to evaluate if participants were performing pharmaceutical management appropriately and to assure that behaviors had not deteriorated. FINDINGS Of 88 participants in the SEP, 36 responded to the survey (response rate 40.9%). There was no significant difference in the behavioral change items of pharmacists immediately after participating in the SEP (2017) and two years later (2019) (4.47 vs. 4.58, P = .47). SUMMARY We confirmed that behavioral changes developed by the SEP were maintained over a significant time. This indicates that knowledge was firmly established in the participants such that they could continue utilizing it long after participating in the SEP. Our study showed that participating in this SEP not only enabled participants to acquire knowledge regarding palliative medicine but also led to continued behavioral changes based on this knowledge.
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Affiliation(s)
- Masahiro Yamada
- Department of Pharmacy, Kitakyushu Municipal Medical Center, 2-1-1, Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka 802-0077, Japan.
| | - Mayako Uchida
- Pharmaceutical Sciences Education and Research Center for Clinical Pharmacy, Osaka University of Pharmaceutical Sciences, 4-20-1 Nasahara, Takatsuki, Osaka 569-1094, Japan.
| | - Masao Hada
- Department of Pharmacy, Japan Community Health care Organization Nankai Medical Center, 7-8, Tokiwanishimachi, Saiki, Oita 876-0857, Japan.
| | - Daigo Inma
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Shunji Ariyoshi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
| | - Hidetoshi Kamimura
- Department of Pharmacy, Fukuoka University Hospital, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Tohru Haraguchi
- A public interest incorporated foundation, Fukuoka Pharmaceutical Association, 2-20-15, Sumiyoshi, Hakata-ku, Fukuoka 812-0018, Japan.
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Bergenholtz H, Missel M, Timm H. Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses. BMC Palliat Care 2020; 19:168. [PMID: 33138799 PMCID: PMC7607873 DOI: 10.1186/s12904-020-00675-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting. Aim The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease. Methods This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting. Results This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries. Conclusion The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12904-020-00675-1.
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Affiliation(s)
- Heidi Bergenholtz
- Holbaek Hospital, Region Zealand, Smedelundsgade 60, 4300, Holbæk, Denmark. .,REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
| | | | - Helle Timm
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark
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An Interprofessional End-of-Life Simulation to Improve Knowledge and Attitudes of End-of-Life Care Among Nursing and Physical Therapy Students. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Alfano CM, Leach CR, Smith TG, Miller KD, Alcaraz KI, Cannady RS, Wender RC, Brawley OW. Equitably improving outcomes for cancer survivors and supporting caregivers: A blueprint for care delivery, research, education, and policy. CA Cancer J Clin 2019; 69:35-49. [PMID: 30376182 DOI: 10.3322/caac.21548] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cancer care delivery is being shaped by growing numbers of cancer survivors coupled with provider shortages, rising costs of primary treatment and follow-up care, significant survivorship health disparities, increased reliance on informal caregivers, and the transition to value-based care. These factors create a compelling need to provide coordinated, comprehensive, personalized care for cancer survivors in ways that meet survivors' and caregivers' unique needs while minimizing the impact of provider shortages and controlling costs for health care systems, survivors, and families. The authors reviewed research identifying and addressing the needs of cancer survivors and caregivers and used this synthesis to create a set of critical priorities for care delivery, research, education, and policy to equitably improve survivor outcomes and support caregivers. Efforts are needed in 3 priority areas: 1) implementing routine assessment of survivors' needs and functioning and caregivers' needs; 2) facilitating personalized, tailored, information and referrals from diagnosis onward for both survivors and caregivers, shifting services from point of care to point of need wherever possible; and 3) disseminating and supporting the implementation of new care methods and interventions.
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Affiliation(s)
| | - Corinne R Leach
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Tenbroeck G Smith
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Kim D Miller
- Senior Associate Scientist, Surveillance Research, American Cancer Society, Atlanta, GA
| | - Kassandra I Alcaraz
- Senior Principal Scientist, Behavioral Research, American Cancer Society, Atlanta, GA
| | - Rachel S Cannady
- Strategic Director, Cancer Caregiver Support, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
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