Practical issues in palliative and quality-of-life care

Palliative care in onco-hematology: a perspective

Palliative care (PC) is focused on individualized symptomatic control, psychological help, and support in the context of severe disease. Oncologic patients are still the most referred to PC and hematologic patients are only 7%. This is a commentary about PC applied to hematologic patients. There is evidence supporting that these patients behave as a special group in PC when compared with other tumors: there is a smaller number of referrals, with more advanced disease status, more symptomatology expressed, and less time between the last treatment date and the referral date or death. This article also expresses the experience of an oncologic palliative care unit. More health education programs in PC are needed for specialized professionals in hematology, as well as a change of nowadays health politics, in order to increase the participation of this specialized care in hematology.

The profile of the onco-hematology patient in the palliative care: 4 years of experience

Objectives:

Most of the palliative care (PC) patients have oncologic diseases, being hematologic tumors a small part of them. According to the literature, onco-hematologic (OH) patients should be individualized from those with solid tumors for the specialized care required along their disease course. This study aims to review the casuistry of OH patients referred to PC in a specialized oncologic hospital and help to understand better how hematologists can improve the care of these patients.

Methods:

We analyzed all OH patients referred to the PC service in 1 oncologic hospital along 42 months, through consultation of their clinical files.

Results:

A total of 179 patients were reviewed (52.% males, median age of 71 years): 48.6% had non-Hodgkin lymphoma, 26.3% had multiple myeloma, 10.6% had acute leukemia, 14.5% had other OH diseases; 88.2% were treated for their OH disease (96.2% with chemotherapy, 28.5% radiotherapy, and 21.5% hematopoietic stem cell transplant). The referral was heterogeneous among physicians (27.4% by 1 physician). Most patients were firstly observed as inpatients (55.3%) and 17.9% in the outpatient consult. At the end of the study, 98.9% of the patients died (88.7% in the hospital, 10.2% at home). The median time between the end of treatment and referral do PC was 46 days and between referral and death was 16 days. We also reviewed medical prescription in the last month of life and we noticed that most invasive orders were requested by hematologists (as antibiotic prescription, imaging, and biopsy studies).

Significance of results:

This study demonstrated that OH patients should be referred earlier to PC and that a more intensive team work needs to be practiced between PC and hematologists. More educational programs for healthcare workers on this issue are needed in order to guarantee a more effective assistance in the appropriate time.

Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary

AIM

To explore collaborative and interdisciplinary palliative educational strategies and corresponding outcomes for health care assistants.

BACKGROUND

Health care assistants are frontline staff who provide almost all hands-on care to seniors. Health care managers are responsible to provide ongoing support and a working environment conducive to health care assistants' abilities to provide quality, safe, evidence-based care.

EVALUATION

A Qualitative metasummary of collaborative and interdisciplinary teaching strategies was conducted following guidelines developed by Sandelowski et al. ().

KEY ISSUES

The gold standard of palliative care is interdisciplinary delivery of care, yet education is often monodisciplinary. Furthermore, evaluation of interdisciplinary continuing education is most often subjective via self-report questionnaires.

CONCLUSIONS

Findings from 16 articles representing 15 studies conducted between 2007 and 2017 were grouped thematically and summarized. Collaborative or interdisciplinary palliative interventions offer health care assistants opportunities to debrief, build their confidence, and critically reflect on the importance of psychosocial care for patients, family and colleagues.

IMPLICATIONS FOR NURSING MANAGEMENT

The metasummary provides six suggestions for managers who are considering implementing a collaborative palliative educational workshop and draws attention to the need to create contextual changes that support health care assistants to enact newly acquired knowledge and skills.

Integrating Quality Palliative and End-of-Life Care into the Geriatric Assessment: Opportunities and Challenges

This article provides an overview of how integrating quality palliative and end-of-life care into geriatric assessment can be a tremendous benefit to older adult patients and their families. Although the quality of palliative and end-of-life care for older adults has improved greatly, there are still many opportunities to improve the quality of life and function for older adult patients in the last few years of their life. More clinical expertise in comprehensive palliative and end-of-life care must be developed and maintained. There also must be greater focus and more direct reimbursement developed for physicians and health system providers.

Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families

There is an escalating prevalence of heart failure (HF) with high mortality. Compared with other races, African Americans face a higher incidence of HF at earlier age of onset, with more rapid progression, and with increased family care burden and greater care costs and disparity in health care services at the end of life (EOL). Concomitant out-of-pocket HF costs and care demands indicate the need for early discussion of palliative and EOL care needs. We therefore developed and pilot tested a culturally sensitive intervention specific to the needs of African American HF patients and their families at the EOL. Our pilot study findings encompass patient and caregiver perspectives and align with the state of EOL science. The ultimate long-term goal of this intervention strategy is to translate into practice the preferred, culturally sensitive, and most cost-efficient EOL care recommendations for HF patients and families.

Palliative Care in Lung Cancer

Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.