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Schindel D, Frick J, Gebert P, Grittner U, Letsch A, Schenk L. The effect of social care nurses on health related quality of life in patients with advanced cancer: A non-randomized, multicenter, controlled trial. Qual Life Res 2024:10.1007/s11136-024-03780-3. [PMID: 39269581 DOI: 10.1007/s11136-024-03780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Daniel Schindel
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Johann Frick
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold- Heller-Straße 3, 24105, Kiel, Germany
- Charité Comprehensive Cancer Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Liane Schenk
- Institute of Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Zhang S, Song H, Liu Q, Zhao M, Bai X, Ding Y, Chen L, Yin H. The effectiveness of brief reminiscence-based psychosocial interventions for cancer patients: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2775-2796. [PMID: 38519834 DOI: 10.1111/jocn.17137] [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: 08/31/2023] [Revised: 12/05/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
AIM To determine the effectiveness of brief reminiscence-based psychosocial interventions in alleviating psychological distress in cancer patients. BACKGROUND Cancer patients suffer tremendous psycho-spiritual pain, which affects their quality of life. Brief reminiscence-based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. DESIGN A systematic review and meta-analysis. METHODS This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. RESULTS Twenty studies involving 1744 cancer participants were included. The meta-analysis showed statistically significant effects of brief reminiscence-based psychosocial interventions on hope, anxiety and depression at post-intervention. A separate analysis revealed that brief reminiscence-based psychosocial interventions had a sustainable effect on hope, spiritual well-being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. CONCLUSIONS Brief reminiscence-based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well-being in cancer patients. RELEVANCE TO CLINICAL PRACTICE This study further supports that brief reminiscence-based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. PATIENT OR PUBLIC CONTRIBUTION All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper.
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Affiliation(s)
- Sitao Zhang
- Jilin University School of Nursing, Changchun, China
| | - Huali Song
- Bethune First Hospital of Jilin University, Changchun, China
| | - Qian Liu
- Jilin University School of Nursing, Changchun, China
| | - Mingzhu Zhao
- Jilin University School of Nursing, Changchun, China
| | - Xuechun Bai
- Jilin University School of Nursing, Changchun, China
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China
| | - Li Chen
- Jilin University School of Nursing, Changchun, China
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China
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Heipon CS, Brom L, van der Linden YM, Tange D, Reyners AKL, Raijmakers NJH. Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study. Support Care Cancer 2024; 32:324. [PMID: 38700723 DOI: 10.1007/s00520-024-08508-0] [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: 08/29/2023] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.
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Affiliation(s)
- Carly S Heipon
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| | - Linda Brom
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Yvette M van der Linden
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patients Organisations, Utrecht, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
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Austin PD, Lee W, Costa DSJ, Ritchie A, Lovell MR. Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials. Heliyon 2024; 10:e29193. [PMID: 38623224 PMCID: PMC11016720 DOI: 10.1016/j.heliyon.2024.e29193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise. Design A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout. Results Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms. Conclusions Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.
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Affiliation(s)
- Philip D. Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Wei Lee
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel SJ. Costa
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Melanie R. Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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Uneno Y, Fukuyama K, Nishimura A, Eguchi K, Kojima H, Umino T, Miyazaki K, Negora E, Minashi K, Sugiyama O, Shimazu T, Muto M, Matsumoto S. Barriers and Facilitators to the Implementation of an Electronic Patient-Reported Outcome System at Cancer Hospitals in Japan. Cureus 2024; 16:e58611. [PMID: 38770482 PMCID: PMC11102941 DOI: 10.7759/cureus.58611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Background and objective Implementing electronic patient-reported outcomes (ePROs) in oncology practice has shown substantial clinical benefits. However, it can be challenging in routine practice, warranting strategies to adapt to different clinical contexts. In light of this, this study aimed to describe the implementation process of the ePRO system and elucidate the provider-level implementation barriers and facilitators to a novel ePRO system at cancer hospitals in Japan. Methods We implemented an ePRO system linked to electronic medical records at three cancer hospitals. Fifteen patients with solid cancers at the outpatient oncology unit were asked to regularly complete the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE™) questionnaire and European Organization for Research and Treatment Core Quality of Life questionnaire (EORTC QLQ C30) by using the smartphone app between October 2021 and June 2022. Thirteen healthcare professionals were interviewed to identify implementation barriers and facilitators to the ePRO system by using the Consolidated Framework for Implementation Research framework. Results The healthcare professionals identified a lack of clinical resources and a culture and system that emphasizes treatment over care as the main barriers; however, the accumulation of successful cases, the leadership of managers, and the growing needs of patients can serve as facilitators to the implementation. Conclusions Our experience implementing an ePRO system in a few Japanese oncology practices revealed comprehensive barriers and facilitators. Further efforts are warranted to develop more successful implementation strategies.
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Affiliation(s)
- Yu Uneno
- Department of Medical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Keita Fukuyama
- Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, JPN
| | - Ayumi Nishimura
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, JPN
| | - Kana Eguchi
- Department of Real World Data R&D, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Hideki Kojima
- Healthcare Solution Department, Marketing Insight Division, INTAGE Healthcare Inc., Tokyo, JPN
| | - Takeshi Umino
- Clinical Research Department, Medical Evidence Division, INTAGE Healthcare Inc., Tokyo, JPN
| | - Kikuko Miyazaki
- Department of Health Informatics, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, JPN
| | - Eiju Negora
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui, Fukui, JPN
| | - Keiko Minashi
- Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, JPN
| | - Osamu Sugiyama
- Department of Informatics, Kindai University, Higashiosaka, JPN
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, JPN
| | - Manabu Muto
- Department of Medical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, JPN
| | - Shigemi Matsumoto
- Department of Real World Data R&D, Graduate School of Medicine, Kyoto University, Kyoto, JPN
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Haug N, Jänicke M, Kasenda B, Marschner N, Frank M. Quantifying bias due to missing data in quality of life surveys of advanced-stage cancer patients. Qual Life Res 2024; 33:1085-1094. [PMID: 38240915 DOI: 10.1007/s11136-023-03588-7] [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] [Accepted: 12/11/2023] [Indexed: 03/09/2024]
Abstract
PURPOSE Many studies on cancer patients investigate the impact of treatment on health-related quality of life (QoL). Typically, QoL is measured longitudinally, at baseline and at predefined timepoints thereafter. The question is whether, at a given timepoint, patients who return their questionnaire (available cases, AC) have a different QoL than those who do not return their questionnaire (non-AC). METHODS We employed augmented inverse probability weighting (AIPW) to estimate the average QoL of non-AC in two studies on advanced-stage cancer patients. The AIPW estimator assumed data to be missing at random (MAR) and used machine learning (ML)-based methods to estimate answering probabilities of individuals at given timepoints as well as their reported QoL, as a function of auxiliary variables. These auxiliary variables were selected by medical oncologists based on domain expertise. We aggregated results both by timepoint and by time until death and compared AIPW estimates to the AC averages. Additionally, we used a pattern mixture model (PMM) to check sensitivity of our AIPW estimates against violation of the MAR assumption. RESULTS Our study included 1927 patients with advanced pancreatic and 797 patients with advanced breast cancer. The AIPW estimate for average QoL of non-AC was below the average QoL of AC when aggregated by timepoint. The difference vanished when aggregated by time until death. PMM estimates were below AIPW estimates. CONCLUSIONS Our results indicate that non-AC have a lower average QoL than AC. However, estimates for QoL of non-AC are subject to unverifiable assumptions about the missingness mechanism.
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Affiliation(s)
- Nina Haug
- iOMEDICO, Biostatistics, Freiburg im Breisgau, Germany.
| | - Martina Jänicke
- iOMEDICO, Clinical Epidemiology and Health Economics, Freiburg im Breisgau, Germany
| | - Benjamin Kasenda
- University Hospital of Basel, Medical Oncology, Basel, Switzerland
| | | | - Melanie Frank
- iOMEDICO, Biostatistics, Freiburg im Breisgau, Germany
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Meneguin S, Pollo CF, Camargo HTF, Honório HM, de Oliveira C. Comparative study of oncology patients' quality of life. Int J Palliat Nurs 2024; 30:120-127. [PMID: 38517853 DOI: 10.12968/ijpn.2024.30.3.120] [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: 03/24/2024]
Abstract
BACKGROUND A cancer diagnosis has a significant impact on a person's life, both physically and emotionally. However, the oncology patients' QoL (QoL) at different stages of the disease has been under investigated. AIM To assess and compare the QoL in three groups of oncology patients. METHODS A comparative study was carried out in an outpatient care service at a public hospital in the state of São Paulo. Data collection involved the use of the Palliative Performance Scale and the McGill QoL Questionnaire. RESULTS Most participants were women, Catholic and living with a partner. The Palliative Performance Scale revealed a predominance of stable patients (score: ≥70 points). Overall, palliative care patients had lower QoL scores compared to the other groups (p<0.01). CONCLUSION QoL was worse among palliative care patients. Advanced age, being in palliative care, and have a low-income were negatively associated with a patient's QoL.
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Affiliation(s)
- Silmara Meneguin
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo, Brazil
| | - Camila Fernandes Pollo
- Department of Nursing, Botucatu Medical School, Paulista State University, São Paulo, Brazil
| | | | - Heitor Marques Honório
- Pediatric Dental Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Brazil
| | - César de Oliveira
- Department of Epidemiology and Public Health, University College London, UK
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Versluis MAJ, Raijmakers NJH, Baars A, van den Beuken-van Everdingen MHJ, de Graeff A, Hendriks MP, de Jong WK, Kloover JS, Kuip EJM, Mandigers CMPW, Sommeijer DW, van der Linden YM, van de Poll-Franse LV. Trajectories of health-related quality of life and symptom burden in patients with advanced cancer towards the end of life: Longitudinal results from the eQuiPe study. Cancer 2024; 130:609-617. [PMID: 37831749 DOI: 10.1002/cncr.35060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Support for health-related quality of life (HRQOL) is an essential part of cancer care in the final stages of life, yet empirical guidance regarding HRQOL and symptom trajectories is lacking. AIM To assess the change in HRQOL and symptom burden in the last year of life in patients with advanced cancer and its association with health care-related factors, cancer-specific treatment, and comorbidity. METHODS A prospective, multicenter, observational study in patients with advanced cancer (eQuiPe). Three monthly questionnaires included European Organization for Research and Treatment of Cancer Quality of Life-C30 and reported continuity of care. Multivariable mixed-effects analysis was used to assess the association between HRQOL and health care-related factors. RESULTS A total of 762 deceased patients were included with a mean age of 66 (SD, 10) years and 52% were male. The most common primary tumors were lung (29%), colorectal (20%), and breast cancer (13%). Mean overall HRQOL decreased in the last 9 months of life, with the greatest decrease in the last 3 months (β -16.2). Fatigue, pain, appetite loss, dyspnea, constipation, and nausea worsened significantly in the last year of life. Multimorbidity (β -7.5) and a better reported continuity of care (β 0.7) were both significantly associated with the trajectory of HRQOL. CONCLUSION Mean overall HRQOL begins to decline 9 months before death, highlighting the need for early identification and (re)assessment of different symptoms as aspects of HRQOL follow different trajectories. Multimorbidity and reported continuity of care may be associated with the trajectory of HRQOL.
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Affiliation(s)
- Moyke A J Versluis
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Graduate School of Social & Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Natasja J H Raijmakers
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Arnold Baars
- Department of Internal Medicine, Hospital Gelderse Vallei, Ede, The Netherlands
| | | | - Alexander de Graeff
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Wouter K de Jong
- Department of Pulmonology, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Jeroen S Kloover
- Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Evelien J M Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Dirkje W Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
- Department of Internal Medicine, Flevoziekenhuis, Almere, The Netherlands
| | - Yvette M van der Linden
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, The Netherlands
| | - Lonneke V van de Poll-Franse
- Research & Development, The Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Wang Y, Zhang X, Huang Y, Ma X. Palliative Care for Cancer Patients in Asia: Challenges and Countermeasures. Oncol Rev 2024; 17:11866. [PMID: 38293617 PMCID: PMC10824851 DOI: 10.3389/or.2023.11866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
With the increasing incidence of cancer worldwide, palliative care has become an effective intervention to relieve cancer patients' pain and improve their quality of life, although the present development of palliative medicine and hospice care in many Asian countries remains insufficient. To this end, this review comprehensively discussed the main challenges that influence the promotion of palliative medicine, from the perspective of both healthcare professionals and cancer patients. We further proposed and summarized a series of potentially effective countermeasures and solutions, including the shared decision-making modal, multidisciplinary professional cooperation, application of modern science and technology, standardization training for medical workers, personalized palliative treatment regimens, and others, aiming to improve the clinical quality of palliative care practice for cancer patients and promote the development of palliative medicine in Asian regions.
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Affiliation(s)
- Yu Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinqing Zhang
- School of Humanities and Social Sciences, Peking Union Medical College, Beijing, China
| | - Yilin Huang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Simão D, Barata PC, Alves M, Papoila AL, Oliveira S, Lawlor P. Symptom Clusters in Patients With Advanced Cancer: A Prospective Longitudinal Cohort Study to Examine Their Stability and Prognostic Significance. Oncologist 2024; 29:e152-e163. [PMID: 37536276 PMCID: PMC10769798 DOI: 10.1093/oncolo/oyad211] [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: 11/11/2022] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
This study's purpose was to assess symptom cluster (SC) stability during disease progression and determine their strength of association with survival in patients with advanced cancer . Consecutively eligible patients with advanced cancer not receiving cancer-specific treatment and referred to a Tertiary Palliative Care Clinic were enrolled in a prospective cohort study. At first consultation (D0) and in subsequent consultations at day 15 (D15) and day 30 (D30), patients rated 9 symptoms through the Edmonton Symptom Assessment System scale (0-10) and 10 others using a Likert scale (1-5). Principal components factor analysis with varimax rotation was used to determine SCs at each consultation. Of 318 patients with advanced cancer, 301 met eligibility criteria with a median age of 69 years (range 37-94). Three SCs were identified: neuro-psycho-metabolic (NPM), gastrointestinal, and sleep impairment, with some variations in their constitution over time. Exploratory factor analysis accounted for 40% of variance of observed variables in all SCs. Shorter median survival was observed continuously for NPM cluster (D0 23 vs. 58 days, P < .001; D15 41 vs. 104 days, P=.004; D30 46 vs. 114 days, P = .002), although the presence of 2 or more SCs on D0 and D15 also had prognostic significance (D0: 21 vs. 45 days, P = .005; D30: 50 vs. 96 days, P = .040). In a multivariable model, NPM cluster (D0 hazard ratio estimate: HR 1.64; 95%CI, 1.17-2.31; P = .005; D15 HR: 2.51; 95%CI, 1.25-5.05; P = .009; D30 HR: 3.9; 95%CI, 1.54-9.86; P = .004) and hospitalization (D0 HR: 2.27; 95%CI, 1.47-3.51; P < .001; D15 HR: 2.43; 95%CI, 1.18-5.01; P = .016; D30 HR: 3.41; 95%CI, 1.35-8.62; P = .009) were independently and significantly associated with worse survival. Three clinically relevant SCs were identified, and their constitution had small variations, maintaining a stable set of nuclear symptoms through disease progression. Presence of the NPM cluster and hospitalization maintained their prognostic value over time.
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Affiliation(s)
- Diana Simão
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pedro C Barata
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Marta Alves
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana L Papoila
- Epidemiology and Statistics Unit, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Sónia Oliveira
- Medical Oncology, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Peter Lawlor
- Bruyere Continuing Care, Division of Palliative Care, Department of Medicine, Bruyere and Ottawa Hospital Research Institutes, University of Ottawa, Ottawa, Canada
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11
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Rouhento EAS, Lehto JT, Kalliomäki ML. Peripheral nerve blocks in advanced cancer pain: retrospective case series. BMJ Support Palliat Care 2023; 13:e287-e290. [PMID: 34857538 DOI: 10.1136/bmjspcare-2021-003293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Patients with cancer often suffer severe pain that is not relieved with systemic analgesics and requires further treatment options. This study aims to investigate whether peripheral nerve blocks are a feasible treatment option in patients with incurable cancer who suffer from severe pain. METHODS All patients with advanced cancer who received a peripheral nerve block for the management of pain at the Tampere University Hospital between January 2015 and December 2018 were included in this retrospective study. The characteristics of the patients' features of the nerve blocks, opioid dosing (daily morphine equivalent) before and after the blocks, and patient-reported pain relief following peripheral block were assessed from the medical records. RESULTS Sixteen of the 17 patients included in this study received pain relief through a nerve block. Daily opioid dose was decreased with the block in 12 (71%) patients with a median change in daily morphine equivalent of -20 mg (IQR: -180 to 9). One infection of the catheter and two other transient adverse events occurred, but none was serious or fatal. CONCLUSIONS Peripheral nerve blocks seem safe and may provide considerable analgesia and decrease the need for opioids in patients with advanced cancer.
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Affiliation(s)
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Tays Cancer Centre, Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Maija-Liisa Kalliomäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Anaesthesia, Tampere University Hospital, Tampere, Finland
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12
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Çelik A, Usta Yeşilbalkan Ö. The Effect of the Bright White Light Application to Cancer Patients Receiving Palliative Care on Their Fatigue Level and Sleep Quality: A Randomized Control Trial. OMEGA-JOURNAL OF DEATH AND DYING 2023; 88:303-317. [PMID: 35532064 DOI: 10.1177/00302228221093462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This study aimed to examine the effect of bright white light on the fatigue level and sleep quality of cancer patients receiving palliative care. The study sample consisted of 52 patients who met the inclusion criteria and were assigned to the study or control group by stratified randomization. The bright white light (10,000 lux) or dim red light (<50 lux) was applied for 30 minutes every morning for 14 days to the patients in the study and control group. In the study, bright white light significantly decreased the level of fatigue and the level of fatigue-related effect on daily life activities, improved sleep quality and increased total sleep time (p < 0.05). It was found that dim red light significantly decreased the level of fatigue and increased the sleep quality, but this change was lower than the study group (p < 0.05).
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Affiliation(s)
- Ayşegül Çelik
- Faculty of Health Sciences, Department of Nursing, İzmir Bakırçay University, Izmir, Türkiye
| | - Öznur Usta Yeşilbalkan
- Nursing Faculty, Department of Internal Medicine Nursing, Ege University, Izmir, Türkiye
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13
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Raunkiær M, Shabnam J, Marsaa K, Kurita GP, Sjøgren P, Guldin MB. When and how to stop palliative antineoplastic treatment and to organise palliative care for patients with incurable cancer. Int J Palliat Nurs 2023; 29:499-506. [PMID: 37862155 DOI: 10.12968/ijpn.2023.29.10.499] [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: 10/22/2023]
Abstract
BACKGROUND Improving the organisational aspects of the delivery of palliative care in order to support patients throughout their disease trajectory has received limited attention. AIM To investigate the opportunities and barriers related to organising palliation for people with terminal cancer and their families. METHODS An explorative interview study was conducted among 31 nurses and three physicians concerning an intervention facilitating a fast transition from treatment at a cancer centre at a university hospital to palliation at home. A thematic analysis was conducted. FINDINGS This article presents three out of seven themes: 1) improvement in the cessation of antineoplastic treatment in palliation; 2) improvement in organisations delivering palliation; and 3) improvement in multidisciplinary and cross-sectoral collaboration. CONCLUSIONS The results demonstrate the demand for flexible, family-centred and integrated palliation at all levels, from communication and the collaborative relationship between healthcare professionals and families to service sectors.
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Affiliation(s)
- Mette Raunkiær
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Jahan Shabnam
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Geana Paula Kurita
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Denmark; Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus, and Institute for Public Health, Aarhus University
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14
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Baykal D, Çömlekçi N. Non-Pharmacologic Approaches to Sleep Problems for Palliative Care Cancer Patients: A Systematic Review. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2023; 31:131-137. [PMID: 37404216 PMCID: PMC10440962 DOI: 10.5152/fnjn.2023.23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/19/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE This present systematic review aims to examine the effectiveness of non-pharmacological approaches to sleep problems for cancer patients in palliative care. METHOD In this review, the data of the last 5 years from 2018 to 2023 are included in Scopus, Web of Science, CINAHL, PubMed, Medline, Ulakbim National Database and Cochrane Library databases were scanned using the keywords "palliative care, sleep disorder, non-pharmacologic, insomnia, cancer, randomized controlled trial" in English and Turkish. As a result of the search, we identified 90 articles. This review was based on Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 Statement recommendations. RESULTS This current review comprised 5 randomized controlled trials. The included studies were found to examine methods such as aromatherapy, massage, therapeutic touch, and white light, leaving out other methods (sleep hygiene, exercise, etc.), which are effective in treating insomnia. We established that the methods discussed in these studies were highly effective in improving sleep quality. CONCLUSION Non-pharmacological methods for treating sleep problems in cancer patients in palliative care have been shown to be effective. We consider it important that nurses were involved in these studies. On the other hand, we would recommend that studies be conducted to evaluate the effect of other nonpharmacologic methods on sleep problems.
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Affiliation(s)
- Dilek Baykal
- Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul, Turkey
| | - Necmiye Çömlekçi
- Department of Nursing, Faculty of Health Sciences, Bartın University, Bartın, Turkey
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15
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Reblin M, Iacob E, Tay DL, Li H, Hebdon MCT, Beck A, Donaldson G, Cloyes KG, Ellington L. Family Caregiver Reports of Their Own and Patient Symptoms in Cancer Home Hospice Approaching End-of-Life. Am J Hosp Palliat Care 2023; 40:508-516. [PMID: 35689339 PMCID: PMC9734284 DOI: 10.1177/10499091221108119] [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] [Indexed: 12/14/2022] Open
Abstract
Context: Family caregivers assume the primary responsibility of assessing and managing hospice cancer patient symptoms while simultaneously managing their own wellbeing and symptoms. Objectives: Describe caregivers' assessment of hospice cancer patient and their own symptoms during the last 60 days of patient life, and assess the relationship between patient and caregiver symptoms over time. Methods: Caregiver symptom report of self and cancer home hospice patient symptom data were collected via telephone in the final 60 days of patient life. Descriptive data on symptom severity and prevalence were summarized. Exploratory Factor Analysis was used to group individual symptoms. Factors representing patient symptoms, caregiver symptoms, and caregiver outlook were analyzed using mixed-effects analysis to determine relationships between factors and change in relationship between factors over time. Results: Data from 61 patient-caregiver dyads are presented. At least 1 day of moderate-to-severe symptoms were reported in the majority of dyads. Significant auto-regressive associations were found, namely previous factor scores for an individual positively predicted the next factor scores for that individual. Previous caregiver report of patient symptoms was also positively associated with the next report of caregiver symptoms; previous caregiver report of their own symptoms were negatively associated with their next report of patient symptoms. Patient and caregiver symptoms and caregiver outlook worsened over time and the relationship between patient and caregiver symptoms strengthened closer to death. Conclusion: Our findings may guide hospice care team responses to caregiver and patient symptoms to promote individual level and unit level functioning.
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Affiliation(s)
- Maija Reblin
- School of Medicine, University of Vermont, Burlington, VT, USA
| | - Eli Iacob
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Hui Li
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Anna Beck
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Gary Donaldson
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | | | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, UT, USA
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16
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Heijltjes MT, van Zuylen L, van Thiel GJ, van Delden JJ, van der Heide A. Symptom evolution in the dying. BMJ Support Palliat Care 2023; 13:121-124. [PMID: 36410945 PMCID: PMC9985713 DOI: 10.1136/spcare-2022-003718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/19/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Provide insight in the prevalence of symptoms in patients who are in the last days of life. METHODS A retrospective descriptive analysis of data on patients who died between 2012 and 2019 at the age of 18 or older in 1 of 20 Dutch healthcare facilities, including hospitals, inpatient hospices and long-term care facilities. We analysed data from 4 hourly registrations in the Care Programme for the Dying Person, to assess for how many patients symptom-related goals of care were not achieved. We looked at the first 4 hours episode after the start of the Care Programme and the last 4 hours episode prior to death. RESULTS We analysed records of 2786 patients. In the first 4 hours episode, at least one symptom-related care goal was not achieved for 28.5%-42.8% of patients, depending on the care setting. In the last 4 hours episode, these percentages were 17.5%-26.9%. Care goals concerning pain and restlessness were most often not achieved: percentages varied from 7.3% to 20.9% for pain and from 9.3% to 21.9% for restlessness. CONCLUSIONS Symptom control at the end of life is not optimal in a substantial minority of patients. Systematic assessment and attention as well as further research on symptom management are of the essence.
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Affiliation(s)
- Madelon T Heijltjes
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Ghislaine Jmw van Thiel
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Johannes Jm van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Jakobsen G, Sjue K, Paulsen Ø, Kaasa S, Hjermstad MJ, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Support Care Cancer 2023; 31:60. [PMID: 36534165 PMCID: PMC9763131 DOI: 10.1007/s00520-022-07537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. METHODS A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). RESULTS Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). CONCLUSION Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807922.
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Affiliation(s)
- Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), and Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- Institute of Clinical Medicine, European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, University of Oslo, Oslo, Norway, and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway, and European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Wang CL, Lin CY, Yang SF. Hospice Care Improves Patients' Self-Decision Making and Reduces Aggressiveness of End-of-Life Care for Advanced Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15593. [PMID: 36497668 PMCID: PMC9735887 DOI: 10.3390/ijerph192315593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The aim of the current study is to evaluate the different degrees of hospice care in improving patients' autonomy in decision-making and reducing aggressiveness of cancer care in terminal-stage cancer patients, especially in reducing polypharmacy and excessive life-sustaining treatments. This was a retrospective cross-sectional study conducted in a single medical center in Taiwan. Patients with advanced cancer who died in 2010-2019 were included and classified into three subgroups: hospice ward admission, hospice shared care, and no hospice care involvement. In total, 8719 patients were enrolled, and 2097 (24.05%) admitted to hospice ward; 2107 (24.17%) received hospice shared care, and 4515 (51.78%) had no hospice care. Those admitted to hospice ward had significantly higher rates of having completed do-not-resuscitate order (100%, p < 0.001) and signed the do-not-resuscitate order by themselves (48.83%, p < 0.001), and they had lower aggressiveness of cancer care (2.2, p < 0.001) within the 28 days before death. Hospice ward admission, hospice shared care, and age > 79 years were negatively associated with aggressiveness of cancer care. In conclusion, our study showed that patients with end-of-life hospice care related to higher patient autonomy in decision-making and less excessively aggressive cancer care; the influence of care was more overt in patients approaching death. Further clinical efforts should be made to clarify the patient and the families' satisfaction and perceptions of quality after hospice care involvement.
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Affiliation(s)
- Chun-Li Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chia-Yen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
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Siafaka V, Mavridis D, Tsonis O, Tzamakou E, Christogiannis C, Tefa L, Arnaoutoglou E, Tzimas P, Pentheroudakis G. The WHOQOL-BREF instrument: Psychometric evaluation of the Greek version in patients with advanced cancer and pain and associations with psychological distress. Palliat Support Care 2022:1-11. [PMID: 35983635 DOI: 10.1017/s1478951522001055] [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: 11/07/2022]
Abstract
OBJECTIVES Assessment of the psychometric characteristics of the Greek version of the brief World Health Organization Quality of Life Instrument (WHOQOL-BREF) in patients with advanced cancer and pain, and exploration of the association between psychological distress and quality of life (QoL). METHOD The sample consisted of 145 patients with advanced cancer and pain who completed the WHOQOL-BREF, the Symptom Checklist-90 (SCL-90), and the Pain Visual Analogue Scale (VAS). In analysis, the following methods were used: Cronbach's alpha, Item Response Theory (IRT), polychoric, Pearson and polyserial correlation, t-test, and Linear regression. RESULTS The internal consistency was high for all domains of the WHOQOL-BREF (Cronbach's α ≥ 0.731). Similarly, with the exception of three items, the WHOQOL-BREF items has large discrimination parameters suggesting that they have a high ability in differentiating subjects. On SCL-90, the three dimensions with the highest scores were Depression, Somatization, and Anxiety. The overall score for psychological distress, the Global Severity Index (GSI), showed significant negative association with all the WHOQOL-BREF factor scores (Physical Health: B = -1.488, p < 0.001, Psychological Health: B = -1.688, p < 0.001, Social Relationships: B = -0.910, p < 0.001, Environment: B = -1.064, p < 0.001). Male gender was associated with lower scores for Social Relationships (B = -0.358, p = 0.007) and Environment (B = -0.293, p = 0.026). SIGNIFICANCE OF RESULTS The Greek version of the WHOQOL-BREF showed good psychometric properties in patients with advanced cancer and can be used as a reliable instrument in clinical practice. The level of psychological distress can be considered a determinant of QoL in patients with advanced cancer and pain, independently of pain intensity or other clinical characteristics. In cancer, the disease process can activate multiple physiological and psychological mechanisms that lead to a wide range of symptoms of psychological distress. To improve their QoL, psychological intervention focused on the identification and alleviation of psychological distress in patients with advanced cancer, and help in finding meaning in their experience, should be provided.
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Affiliation(s)
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Orestis Tsonis
- Department of Obstetrics and Gynecology, University Hospital of Ioannina, Ioannina, Greece
| | | | | | - Louiza Tefa
- Department of Anesthesiology, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Petros Tzimas
- Department of Anesthesiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - George Pentheroudakis
- Department of Oncology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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20
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Systematic self-reporting of patients’ symptoms: improving oncologic care and patients’ satisfaction. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
In recent years, there has been a growing interest to enhance patients’ symptom management during routine cancer care using patient-reported outcome measures. The goal of this study is to analyse patients’ responses to the Edmonton Symptom Assessment System (ESAS) to determine whether patient-reported outcomes could help characterise those patients with the highest supportive care needs and symptom burden in order to help provide targeted support for patients.
Methods:
In this study, we analysed ESAS questionnaire responses completed by patients as part of their routine care and considered part of patients’ standard of care. Statistical analyses were performed using the IBM SPSS Statistics version 26.0. Descriptive statistics are used to summarise patient demographics, disease characteristics and patient-reported symptom severity and prevalence.
Results:
The overall mean age is 65.2 ± 12.8 years comprising 43.8% male and 56.2% female patients. The five common primary disease sites are breast (26.2%), haematology (21.1%), gastrointestinal (15.3%), genitourinary (12.7%) and lung (12.0%) cancers. The mean severity for each symptom is all mild (score: 1–3). The three most common reported symptoms causing distress are tiredness, poor overall wellbeing and anxiety, and the least reported symptom is nausea.
Conclusions:
Systematic self-reporting of patients’ symptoms is important to improve symptom management, timely facilitation of appropriate intervention, patient experience, and patient and family satisfaction. The awareness of disease site, gender and age-related symptom variations should help in the design and provision of appropriate symptom-directed, tumour-specific and patient-focused interventions to meet patients’ immediate needs.
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Sørensen J, Sjøgren P, Stine C, Sørensen TV, Heinecke K, Larsen H, Eidemak I, Kurita GP. Patient-reported outcome measures (PROMs) and palliative-care clinician reported outcomes (ClinROs) mutually improve pain and other symptoms assessment of hospitalized cancer-patients. Scand J Pain 2022; 22:569-577. [PMID: 35179007 DOI: 10.1515/sjpain-2021-0162] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with malignant diseases are known to have a high symptom burden including pain, and insufficient treatment of pain in this population has been frequently documented. To promote the integration of specialized palliative care and hematology and oncology, this study investigated disease, treatment, and comorbidity related symptoms as well as functional capacity and health-related quality of life (HQoL) by patient-reported outcome measures (PROMs) and clinician-reported outcome measures (ClinROs) among inpatients in a comprehensive cancer center. METHODS This cross-sectional study was carried out in a large comprehensive cancer centre of both oncological and hematological inpatients. It combined the use of PROMs and ClinROs. RESULTS A high symptom burden was reported with fatigue and appetite loss as the most frequent symptoms, and role function being the most impaired function. Further, a low HQoL score was associated with a high number of symptoms/impairments. More than half of all patients reported pain in the last 24 h. Out of 95 patients with average pain >0 in the last 24 h, 71% were treated with opioids and 24% were treated with adjuvant analgesic (AA) defined as antiepileptics, antidepressants and prednisolone. Out of 57 patients with average pain >0 in the last 24 h and possible neuropathic pain, 33% were treated with AAs. A high odds ratio for moderate/severe pain in patients with possible neuropathic pain mechanisms was observed. CONCLUSIONS AND IMPLICATIONS This study did not only emphasize the need for systematic use of PROMs to identify symptoms and needs for inpatients, but also displayed why PROMs supported by ClinROs are a prerequisite to deliver truly individualized and high-quality patient-centered care. This study calls for continuous training of health care professionals to deliver high-quality treatment of pain. Further, it contributes to the growing recognition, that palliative care and standard care must be integrated to strengthen patient-centered care.
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Affiliation(s)
- Jonas Sørensen
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Clemmensen Stine
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tanja Vibeke Sørensen
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Katja Heinecke
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Larsen
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Inge Eidemak
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Geana Paula Kurita
- Department of Oncology, Section of Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology and Multidisciplinary Pain Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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22
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Al Qadire M, Al Omari O, Alaloul F, Musa A, Aloush S. Assessment of symptoms among among patients living with cancer: prevalence, distress and its correlation with quality of life. Int J Palliat Nurs 2022; 28:270-279. [PMID: 35727829 DOI: 10.12968/ijpn.2022.28.6.270] [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: 11/11/2022]
Abstract
Background: Several symptoms known to be experienced by cancer patients receiving palliative care remain under-reported, inadequately managed and unexplored in Jordan. Aim: To describe the prevalence of symptoms, the distress caused and the correlation with quality-of-life among cancer patients receiving palliative care in Jordan. Methods: A cross-sectional correlational survey design was used. The Rotterdam Symptom Checklist and the Quality-of-Life Index-Cancer version were used for data collection. Data were analysed using descriptive statistics, unpaired t-test and Pearson correlation coefficients. Results: The sample comprises of 124 patients with a mean age of 55.7 years (SD=12.9). A total of 57.3% of them were females. Patients reported having an average of 17.3 (SD=7.1) symptoms. The most reported symptoms were tiredness (90.3%), lack of energy (81.5%), sore muscles (81.5%) and worry (76.6%). The mean total score for quality of life was 17.9 (SD=5.9) out of 30. A negative (P<0.05) relationship was found between the number of concurrent symptoms and the total quality of life score. Conclusions: Palliative care patients in Jordan reported a high number of co-occurring symptoms and experienced high levels of symptom distress, which negatively impacted their quality of life. Further research to evaluate the impact of total symptom management, its efficacy and feasibility is needed.
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Affiliation(s)
- Mohammad Al Qadire
- Professor, College of Nursing, Sultan Qaboos University, Sultanate of Oman; Adult Health Department, Al Al-Bayt University, Jordan
| | - Omar Al Omari
- Associate Professor, Sultan Qaboos University, Sultanate of Oman
| | - Fawwaz Alaloul
- Associate Professor, Sultan Qaboos University, Sultanate of Oman
| | - Ahmad Musa
- Associate Professor, Al Al-Bayt University, Jordan
| | - Sami Aloush
- Associate Professor, Al Al-Bayt University, Jordan
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Frick J, Gebert P, Grittner U, Letsch A, Schindel D, Schenk L. Identifying and handling unbalanced baseline characteristics in a non-randomized, controlled, multicenter social care nurse intervention study for patients in advanced stages of cancer. BMC Cancer 2022; 22:560. [PMID: 35585571 PMCID: PMC9118792 DOI: 10.1186/s12885-022-09646-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose Given the psychosocial burdens patients in advanced stages of cancer face, innovative care concepts are needed. At the same time, such vulnerable patient groups are difficult to reach for participation in intervention studies and randomized patient inclusion may not be feasible. This article aims to identify systematic biases respectively selection effects occurring during the recruitment phase and to discuss their potential causes based on a non-randomized, multicenter intervention study with patients in advanced stages of cancer. Methods Patients diagnosed with at least one of 16 predefined cancers were recruited at four hospitals in three German cities. The effect of social care nurses’ continuous involvement in acute oncology wards was measured by health-related quality of life (EORTC QLQ-C30), information and participation preferences, decisional conflicts, doctor-patient communication, health literacy and symptom perception. Absolute standardized mean difference was calculated as a standardized effect size to test baseline characteristics balance between the intervention and control groups. Results The study enrolled 362 patients, 150 in the intervention and 212 in the control group. Except for gender, both groups differed in relevant socio-demographic characteristics, e.g. regarding age and educational background. With respect to the distribution of diagnoses, the intervention group showed a higher symptom burden than the control group. Moreover, the control group reported better quality of life at baseline compared to the intervention group (52.6 points (SD 21.7); 47.8 points (SD 22.0), ASMD = 0.218, p = 0.044). Conclusion Overall, the intervention group showed more social and health vulnerability than the control group. Among other factors, the wide range of diagnoses included and structural variation between the recruiting clinics increased the risk for bias. We recommend a close, continuous monitoring of relevant social and health-related characteristics during the recruitment phase as well as the use of appropriate statistical analysis strategies for adjustment, such as propensity score methods. Trial registration: German Clinical Trials Register (DRKS-ID: DRKS00013640); registered on 29th December 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09646-6.
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Affiliation(s)
- Johann Frick
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
| | - Pimrapat Gebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Ulrike Grittner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Anne Letsch
- Department of Medicine II, Hematology and Oncology, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Comprehensive Cancer Center, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Schindel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
| | - Liane Schenk
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany
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25
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Zhang Y, Li J, Hu X. The effectiveness of dignity therapy on hope, quality of life, anxiety, and depression in cancer patients: A meta-analysis of randomized controlled trials. Int J Nurs Stud 2022; 132:104273. [DOI: 10.1016/j.ijnurstu.2022.104273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/07/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2022]
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26
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KARAMAN E, SAYIN KASAR K, DENİZ K, YILDIRIM Y. Symptoms, performance status and quality of life in cancer patients receiving palliative care. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1085738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Symptom Burden and Complexity in the Last 12 Months of Life among Cancer Patients Choosing Medical Assistance in Dying (MAID) in Alberta, Canada. Curr Oncol 2022; 29:1605-1618. [PMID: 35323335 PMCID: PMC8947648 DOI: 10.3390/curroncol29030135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: In 2019, cancer patients comprised over 65% of all individuals who requested and received Medical Assistance in Dying (MAID) in Canada. This descriptive study sought to understand the self-reported symptom burden and complexity of cancer patients in the 12 months prior to receiving MAID in Alberta. Methods: Between July 2017 and January 2019, 337 cancer patients received MAID in Alberta. Patient characteristics were descriptively analyzed. As such, 193 patients (57.3%) completed at least one routine symptom-reporting questionnaire in their last year of life. Mixed effects models and generalized estimating equations were utilized to examine the trajectories of individual symptoms and overall symptom complexity within the cohort over this time. Results: The results revealed that all nine self-reported symptoms, and the overall symptom complexity of the cohort, increased as patients’ MAID provision date approached, particularly in the last 3 months of life. While less than 20% of patients experienced high symptom complexity 12 months prior to MAID, this increased to 60% in the month of MAID provision. Conclusions: Cancer patients in this cohort experienced increased symptom burden and complexity leading up to their death. These findings could serve as a flag to clinicians to closely monitor advanced cancer patients’ symptoms, and provide appropriate support and interventions as needed.
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Yasar N, Akin S, Salmanoglu M. Symptom experience and care needs of Turkish palliative care patients. Int J Palliat Nurs 2022; 28:123-131. [PMID: 35452265 DOI: 10.12968/ijpn.2022.28.3.123] [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: 11/11/2022]
Abstract
BACKGROUND Nurses need to focus on supporting patients' quality of life, supporting their families, reducing the morbidity rate, providing psychosocial support services to improve symptom management and delivering high-quality care. AIM This study aimed to determine the symptom experience and care needs of Turkish patients who received inpatient treatment in palliative care units. METHODS This descriptive research was conducted between May 2019 and May 2020. The study sample was composed of 200 palliative care patients selected using a convenience-purposive sampling method. The personal and disease-related characteristics were collected using the Patient Information Survey and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale. FINDINGS The mean age of the sample was 75±15 years, and 56.5% were women. The patients' overall quality of life scores were below average (mean 84.05±19.44). The functional wellbeing and other concerns subscales of the scale were affected the most adversely. The Physical Wellbeing subscale was affected minimally, while the Emotional Wellbeing and Social Wellbeing subscales were affected moderately. Conclusion: The palliative care patients mostly needed support for the prevention and management of infections, management of respiratory distress and swallowing problems, dealing with confusion and improving compliance with treatment. The low quality of life scores emphasise the importance of urgent interventions for improving the functional wellbeing and symptom management in these patients.
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Affiliation(s)
- Neslisah Yasar
- PhD Candidate, Vocational School, Beykent University, Turkey
| | - Semiha Akin
- Professor, Hamidiye Faculty of Nursing, University of Health Sciences, Turkey
| | - Musa Salmanoglu
- Assistant Professor, Abdulhamid Han Training and Research Hospital, University of Health Sciences, Turkey
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Bye A, Bjerkeset E, Stensheim H, Loge JH, Hjermstad MJ, Klepstad P, Habberstad R, Kaasa S, Aass N. Benefits of Study Participation for Patients with Advanced Cancer Receiving Radiotherapy: A Prospective Observational Study. Palliat Med Rep 2022; 3:264-271. [PMID: 36876292 PMCID: PMC9983125 DOI: 10.1089/pmr.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background Patients with advanced cancer and bone metastases may have unmet palliative care (PC) needs that go unnoticed during clinical oncological practice. This observational study describes interventions that were initiated as the patients participated in the Palliative Radiotherapy and Inflammation Study (PRAIS). It was hypothesized that the patients would benefit from study participation due to PC interventions initiated by the study team. Methods A retrospective review of patients' electronic records. Patients with advanced cancer and painful bone metastases included in PRAIS were eligible. All patients met with the study team before start of radiotherapy, after completion of Patient Reported Outcome Measures. Interventions initiated by the study team were documented in the patients' electronic records. Results A total of 133 patients were reviewed: 63% males, mean (standard deviation [SD]) age 65 (9.6) and mean (SD) Karnofsky performance status (KPS) score 73.2 (9.1). Interventions were initiated in 50% (n = 67) of the patients. Changes in opioid management (69%), treatment of constipation (43%), and nausea (24%) and nutritional advice were most frequent (21%). Patients receiving interventions had lower mean KPS (70 vs. 77 p < 0.001), shorter survival time after study inclusion (median 28 vs. 57.5 weeks p = 0.005) and were more often opioid naïve (12% vs. 39% p < 0.001) than those not receiving interventions by the study team. Conclusions Patients with advanced cancer and painful bone metastasis benefited from study participation due to multiple PC interventions initiated by the study team. The findings call for a systematic integration of PC in patients with advanced cancer. Trial Registration ClinicalTrials.gov NCT02107664.
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Affiliation(s)
- Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ellen Bjerkeset
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Hanne Stensheim
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Jon H Loge
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Marianne J Hjermstad
- European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Pal Klepstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Anesthesiology and Intensive Care Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ragnhild Habberstad
- European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Nina Aass
- European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
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Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Perry LM, Sartor O, Malhotra S, Alonzi S, Kim S, Voss HM, Rogers JL, Robinson W, Harris K, Shank J, Morrison DG, Lewson AB, Fuloria J, Miele L, Lewis B, Mossman B, Hoerger M. Increasing Readiness for Early Integrated Palliative Oncology Care: Development and Initial Evaluation of the EMPOWER 2 Intervention. J Pain Symptom Manage 2021; 62:987-996. [PMID: 33864847 PMCID: PMC8526633 DOI: 10.1016/j.jpainsymman.2021.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Early integrated palliative care improves quality of life, but palliative care programs are underutilized. Psychoeducational interventions explaining palliative care may increase patients' readiness for palliative care. OBJECTIVES To 1) collaborate with stakeholders to develop the EMPOWER 2 intervention explaining palliative care, 2) examine acceptability, 3) evaluate feasibility and preliminary efficacy. METHODS The research was conducted at a North American cancer center and involved 21 stakeholders and 10 patient-participants. Investigators and stakeholders iteratively developed the intervention. Stakeholders rated acceptability of the final intervention. Investigators implemented a pre-post trial to examine the feasibility of recruiting 10 patients with metastatic cancer within one month and with a ≥50% consent rate. Preliminary efficacy outcomes were changes in palliative care knowledge and attitudes. RESULTS Using feedback from four stakeholder meetings, we developed a multimedia intervention tailored to three levels of health-literacy. The intervention provides knowledge and reassurance about the purpose and nature of palliative care, addressing cognitive and emotional barriers to utilization. Stakeholders rated the intervention and design process highly acceptable (3.78/4.00). The pilot met a priori feasibility criteria (10 patients enrolled in 14 days; 83.3% consent rate). The intervention increased palliative care knowledge by 83.1% and improved attitudes by 18.9 points on a 0 to 51 scale (Ps < 0.00001). CONCLUSIONS This formative research outlines the development of a psychoeducational intervention about palliative care. The intervention is acceptable, feasible, and demonstrated promising pilot test results. This study will guide clinical teams in improving patients' readiness for palliative care and inform the forthcoming EMPOWER 3 randomized clinical trial.
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Affiliation(s)
| | | | - Sonia Malhotra
- Tulane University, New Orleans, Louisiana, USA; University Medical Center New Orleans, New Orleans, Louisiana, USA
| | | | - Seowoo Kim
- Tulane University, New Orleans, Louisiana, USA
| | | | | | - William Robinson
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | | | - David G Morrison
- The Oncology Institute of Hope and Innovation, New Orleans, Louisiana, USA
| | - Ashley B Lewson
- Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Jyotsna Fuloria
- University Medical Center New Orleans, New Orleans, Louisiana, USA
| | - Lucio Miele
- Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Lewis
- Tulane University, New Orleans, Louisiana, USA
| | | | - Michael Hoerger
- Tulane University, New Orleans, Louisiana, USA; University Medical Center New Orleans, New Orleans, Louisiana, USA.
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Crane S, DiValerio Gibbs K, Nosich R, Yang Y, Pawelek E. Challenges in the implementation of electronic systems for patient report of symptoms in oncology: a scoping review. JOURNAL OF HOSPITAL MANAGEMENT AND HEALTH POLICY 2021; 5:31. [PMID: 38919373 PMCID: PMC11198977 DOI: 10.21037/jhmhp-20-108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Background Under-recognition and under-treatment of symptoms are prevalent throughout the health care system in the United States. While the reasons for this are complex, it is widely recognized that electronic symptom reports can improve clinicians' ability to manage symptoms. However, electronic symptom reporting has yet to be widely implemented. Electronic systems are most effective when tailored to the specific patient population or clinical setting. For example, numerous oncology-focused electronic symptom reporting systems have been developed for patients with cancer undergoing treatment in the United States. The objective of this scoping review was to identify challenges that arose in the implementation of electronic systems for patient-reported symptoms in oncology clinical practice, and approaches that were taken or recommended to overcome those challenges. Methods This scoping review involved comprehensive searches of Medline, CINAHL, and the Cochrane Central Register of Controlled Trials, which yielded 3,133 articles. Following screening, 20 research studies met the inclusion criteria and were included in this review. Data were systematically extracted from the articles using a qualitative content analysis. Results Challenges identified were thematically categorized as technical issues, system usability issues, patient lack of comfort/knowledge of technology, incomplete/missing data, lack of patient use of the system, other patient issues, difficulties timing completion with clinical processes, lack of clinic staff involvement/engagement, and lack of clinician comfort/knowledge regarding the use of patient-reported outcome data. Discussion The findings of this review highlight challenges that need to be addressed when implementing an electronic symptom reporting system for patients with cancer, and potential strategies for overcoming these challenges. This review may help hospital administrators and clinicians prepare for and improve the implementation of electronic symptom reporting systems into clinical practice, thereby providing evidence to enable their broader use.
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Affiliation(s)
- Stacey Crane
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Karen DiValerio Gibbs
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rebecca Nosich
- Harris College of Nursing & Health Sciences, Texas Christian University, Houston, TX, USA
| | - Yijiong Yang
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elizabeth Pawelek
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, USA
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Bland KA, Harrison M, Zopf EM, Sousa MS, Currow DC, Ely M, Agar M, Butcher BE, Vaughan V, Dowd A, Martin P. Quality of Life and Symptom Burden Improve in Patients Attending a Multidisciplinary Clinical Service for Cancer Cachexia: A Retrospective Observational Review. J Pain Symptom Manage 2021; 62:e164-e176. [PMID: 33652095 DOI: 10.1016/j.jpainsymman.2021.02.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cancer cachexia negatively affects quality of life (QoL) and increases symptom burden. A multimodal treatment approach may optimize cachexia outcomes, including QoL. We evaluated QoL and symptoms over time among patients attending a multidisciplinary clinical service for cancer cachexia. METHODS Adults with cancer who attended the clinical service three times between 2017 and 2020 were included. Quality of life and symptoms were assessed using the European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) and the Functional Assessment Anorexia/Cachexia Therapy (FAACT) questionnaires. Physical function was assessed using the 30s sit-to-stand test and handgrip strength. RESULTS Overall, 162 patients (age = 67.2 ± 12.0 years) were included. Mean six-month weight loss at baseline was 10.4% ± 9.4%. Mean body weight was stable between clinic visits (P = 0.904) and no change in sit-to-stand repetitions (P = 0.133) or handgrip strength (P = 0.734) occurred over time. Improvements in EORTC QLQ-C15-PAL overall QoL (Δ10.7 ± 2.5, P < 0.001), physical function (Δ8.0 ± 2.4, P = 0.003) and emotional function (Δ11.4 ± 2.9, P < 0.001) occurred by the second visit. EORTC QLQ-C15-PAL fatigue (Δ13.8 ± 2.9, P < 0.001), pain (Δ10.3 ± 3.3, P = 0.007), nausea/vomiting (Δ16.1 ± 3.0, P < 0.001) and appetite symptoms (Δ25.9 ± 3.8, P < 0.001) also improved by the second visit. FAACT total score (Δ14.6 ± 2.7, P < 0.001), anorexia-cachexia symptoms (Δ6.6 ± 1.1, P< 0.001), and physical (Δ3.7 ± 0.70, P < 0.001), emotional (Δ1.9 ± 0.60, P = 0.005) and functional wellbeing (Δ2.7 ± 0.71, P = 0.001) improved by the second visit. All improvements in EORTC QLQ-C15-PAL and FAACT outcomes were maintained at the third visit. CONCLUSION Significant improvements in QoL and symptoms were associated with attending a cancer cachexia clinical service. Our findings support using multidisciplinary, multimodal cancer cachexia treatment approaches to improve patient wellbeing.
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Affiliation(s)
- Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, Australia
| | - Meg Harrison
- School of Medicine, Deakin University, Geelong, VIC, Australia; Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, Australia
| | - Mariana S Sousa
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Matthew Ely
- Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Meera Agar
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Belinda E Butcher
- WriteSource Medical Pty Ltd., Lane Cove, NSW, Australia; School of Medical Sciences, University of New South Wales, UNSW, Sydney, Australia
| | - Vanessa Vaughan
- School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Anna Dowd
- Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Peter Martin
- School of Medicine, Deakin University, Geelong, VIC, Australia; Palliative Care, Barwon Health, Geelong, VIC, Australia.
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Guiteras AF, Abelló HV, Domingo JP, Danés CF, Ripoll AR, Berger R. Palliative Oncological Patients with Insomnia: Concerns of the Patients and Their Relatives' Perception. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168509. [PMID: 34444258 PMCID: PMC8392089 DOI: 10.3390/ijerph18168509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
Insomnia is one of the most frequent symptoms and usually generates significant stress in 60% of patients with advanced cancer. Worries from the patients' and relatives' perspective are crucial to improve the patients' quality of life but have received limited attention. The aims were to identify the concerns of patients with insomnia in the terminal illness stage in a palliative care unit and the relatives' perception, and to compare both. Here, 63 patients and 53 relatives answered a questionnaire about worries in the personal, spiritual, family-related and economic area, as well as a quality-of-life uniscale. The results showed that the relatives' most frequent concern was "Having lived life to the fullest" (100%), and the most intense was "The possible suffering during the process" (9.2/10). The patients' most expressed concern was: "Having unfinished business" (100%), and the most intense was "Suffering during the process" (9.3/10). Quality of life showed an average value of 6.95 out of 10. Relatives only coincided significantly in: "Not knowing what happens after death" (r = 0.600; p = 0.000). These results bring visibility to concerns during the final stage of oncological palliative patients with insomnia from the patients' and relatives' perspective. Knowing both is useful for professionals to foster the well-being for a short, yet very important, period for patients, relatives and the caregiving team.
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Affiliation(s)
- Antoni Font Guiteras
- Department de Psicologia Bàsica, Evolutiva i de la Educació, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.F.G.); (H.V.A.)
| | - Helena Villar Abelló
- Department de Psicologia Bàsica, Evolutiva i de la Educació, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.F.G.); (H.V.A.)
| | - José Planas Domingo
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Cristina Farriols Danés
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Ada Ruiz Ripoll
- Palliative Care Unit, Geriatric Department, Centre Fòrum, Hospital del Mar, 08003 Barcelona, Spain; (J.P.D.); (C.F.D.); (A.R.R.)
| | - Rita Berger
- Departamento de Psicología Social y Cuantitativa, Universitat de Barcelona, 08035 Barcelona, Spain
- Correspondence:
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Cadogan CA, Murphy M, McLean S, Bennett K, Hughes CM. Development of criteria for identifying potentially inappropriate prescribing in older adults with cancer receiving palliative care (PIP-CPC). J Geriatr Oncol 2021; 12:1193-1199. [PMID: 34144924 DOI: 10.1016/j.jgo.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/03/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To develop criteria for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults (≥65 years) with cancer who are receiving palliative care and have an estimated life expectancy of <1 year. MATERIALS AND METHODS A two-round Delphi exercise was conducted using web-based questionnaires. A panel of 18 expert stakeholders with expertise in palliative care, oncology and/or geriatric medicine across Ireland and the United Kingdom rated their level of agreement with each statement using a 5-point Likert scale and had the option of adding free-text comments throughout the questionnaire. A priori decision rules were used to accept or reject criteria. RESULTS Twenty-eight criteria were presented in Round 1. Group consensus was achieved for 15 criteria which were included in the final set of criteria. Following a review of the panel's ratings and additional comments for the remaining 13 criteria, four criteria were removed from Round 2. Group consensus was achieved for all nine criteria included in Round 2. The final set comprised 24 criteria relating to: anorexia-cachexia (n = 1); anxiety (n = 2); constipation (n = 5); delirium (n = 1); depression (n = 3); diarrhoea (n = 1); dyspnoea/breathlessness (n = 1); fatigue (n = 2); insomnia (n = 2); nausea and vomiting (n = 2); pain (n = 3); duplicate drug classes (n = 1). CONCLUSION A consensus-agreed set of prescribing criteria has been developed for identifying potentially inappropriate prescribing of medications for symptomatic relief in older adults with cancer who are receiving palliative care and have an estimated life expectancy of less than one year. Future studies should examine the application and validity of these criteria.
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Affiliation(s)
- Cathal A Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland.
| | - Melanie Murphy
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin, Ireland
| | - Sarah McLean
- St Vincent's Private Hospital, Merrion Road, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin, Ireland
| | - Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, United Kingdom
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Thronæs M, Løhre ET, Kvikstad A, Brenne E, Norvaag R, Aalberg KO, Moen MK, Jakobsen G, Klepstad P, Solberg A, Solheim TS. Interventions and symptom relief in hospital palliative cancer care: results from a prospective longitudinal study. Support Care Cancer 2021; 29:6595-6603. [PMID: 33942192 PMCID: PMC8464577 DOI: 10.1007/s00520-021-06248-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the use of interventions and symptom relief for adult patients with incurable cancer admitted to an acute palliative care unit providing integrated oncology and palliative care services. METHODS All admissions during 1 year were assessed. The use of interventions was evaluated for all hospitalizations. Patients with assessments for worst and average pain intensity, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety, well-being, constipation, and sleep were evaluated for symptom development during hospitalization. Descriptive statistics was applied for the use of interventions and the paired sample t-test to compare symptom intensities (SIs). RESULTS For 451 admissions, mean hospital length of stay was 7.0 days and mean patient age 69 years. More than one-third received systemic cancer therapy. Diagnostic imaging was performed in 66% of the hospitalizations, intravenous rehydration in 45%, 37% received antibiotics, and 39% were attended by the multidisciplinary team. At admission and at discharge, respectively, 55% and 44% received oral opioids and 27% and 45% subcutaneous opioids. For the majority, opioid dose was adjusted during hospitalization. Symptom registrations were available for 180 patients. Tiredness yielded the highest mean SI score (5.6, NRS 0-10) at admission and nausea the lowest (2.2). Significant reductions during hospitalization were reported for all assessed SIs (p ≤ 0.01). Patients receiving systemic cancer therapy reported symptom relief similar to those not on systemic cancer therapy. CONCLUSION Clinical practice and symptom relief during hospitalization were described. Symptom improvements were similar for oncological and palliative care patients.
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Affiliation(s)
- Morten Thronæs
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway. .,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
| | - Erik Torbjørn Løhre
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Anne Kvikstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Elisabeth Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Robin Norvaag
- Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Kathrine Otelie Aalberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Martine Kjølberg Moen
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunnhild Jakobsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Solberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
| | - Tora Skeidsvoll Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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Pergolizzi D, Monforte-Royo C, Balaguer A, Porta-Sales J, Rodriguez-Prat A, Crespo I. Older Age: A Protective Factor Against Perceived Dignity-Related Distress in Patients With Advanced Cancer? J Pain Symptom Manage 2021; 61:928-939. [PMID: 33038428 DOI: 10.1016/j.jpainsymman.2020.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Most older adults will face threats to loss of health and social support, which can affect their perceived dignity. Although problems with perceived dignity increase in the context of cancer, the specific experience for those older compared with younger patients with advanced cancer has not been described despite its contributions to the wish to hasten death (WTHD). OBJECTIVES To understand the influence of age group to the perception of dignity, considering changes in quality of life and the WTHD in patients with advanced cancer. METHODS The Patient Dignity Inventory was administered to 194 patients with advanced cancer. The data were analyzed by separating the sample into age groups younger than 65 years (N = 106) or 65 years and older (N = 88). Linear regression models were adjusted with the explanatory variables of WTHD, quality of life, as well as functional status, physical dependence, depression, anxiety, and sociodemographic variables. RESULTS Older patients showed a 2.6% decrease in the total scores of perceived dignity-related distress compared to younger patients. CONCLUSION Older age could be a protective factor against the perception of loss of dignity in patients with advanced cancer, a more positive perspective of the aging experience.
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Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain.
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Josep Porta-Sales
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Institut Català d'Oncologia (ICO), Girona, Spain
| | - Andrea Rodriguez-Prat
- Faculty of Humanities, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Drageset S, Austrheim G, Ellingsen S. Quality of life of women living with metastatic breast cancer and receiving palliative care: A systematic review. Health Care Women Int 2021; 42:1044-1065. [PMID: 33798012 DOI: 10.1080/07399332.2021.1876063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The quality of life (QoL) of women living with metastatic breast cancer and receiving palliative care needs more attention. We reviewed published studies (1992-2019) examining QoL of women receiving palliative care. The findings were interpreted according to the World Health Organization's (WHO) definition of palliative care. Four themes emerged: (1) the impact of medical treatment on pain relief; (2) the need for psychosocial attention and support; (3) the necessity of an interdisciplinary approach; (4) ambiguous understanding of the term palliative care. A common understanding of the term palliative care and more research is needed to enhance the QoL of women living with metastatic breast cancer.
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Affiliation(s)
- Sigrunn Drageset
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Faculty of Health Studies, VID Specialized University - Haraldsplass, Bergen, Norway
| | - Gunhild Austrheim
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sidsel Ellingsen
- Faculty of Health Studies, VID Specialized University - Haraldsplass, Bergen, Norway.,Faculty of Health Studies and Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Nishijima K, Kizawa Y, Yamauchi T, Odagiri T, Ito T, Kaneishi K, Shimizu K, Morita T, Mori M. Prevalence and associated factors of orphan symptoms in advanced cancer patients: a multicenter observational study. Support Care Cancer 2021; 29:5537-5547. [PMID: 33725175 DOI: 10.1007/s00520-021-06144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aims of this study were to examine the prevalence of myoclonus, sweating, pruritus, hiccup, and vesical and rectal tenesmus, and to explore associated factors in patients with advanced cancer. METHODS This multicenter prospective cohort study was conducted in 23 inpatient hospices/palliative care units in Japan from January to December 2017. The prevalence and characteristics of each symptom were assessed on admission and in the 3 days before death. We selected factors that might influence the occurrence of each symptom and investigated the association. RESULTS A total of 1896 patients were enrolled. The prevalence of orphan symptoms rose from admission to the 3 days before death: myoclonus 1.3 to 5.3% (95% CI 0.9-1.9%/4.3-6.5%), sweating 1.8 to 4.1% (95% CI 1.3-2.6%/3.1-5.1%), hiccup 1.1 to 1.8% (95% CI 0.7-1.7%/1.2-2.6%), and tenesmus 0.7 to 0.9% (0.4-1.2%/0.5-1.5%). Prevalence of pruritus fell from 3.5 to 2.5% (95% CI 2.7-4.4%/1.8-3.4%). Sweating, pruritus, and hiccups persisted throughout the day in nearly half of the patients. Myoclonus was significantly associated with brain tumors, sweating with opioids and antipsychotics, pruritus with liver and biliary tract cancer, cholestasis and severe diabetes, hiccup with male gender, digestive tract obstruction, severe diabetes, and renal failure. Vesical tenesmus was associated with urinary cancer, antipsychotics, and anticholinergics and rectal tenesmus with pelvic cavity cancer. CONCLUSION We found that orphan symptoms occurred in 0.5-5.0% of patients, increased over time except for pruritus, and persisted in half of the patients.
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Affiliation(s)
- Kaoru Nishijima
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | | | - Takuya Odagiri
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Tetsuya Ito
- Department of Palliative Care, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Keisuke Kaneishi
- Department of Palliative Care Unit, JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Keiji Shimizu
- Department of Palliative Care Internal Medicine, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
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Fatigue in Cancer Patients in Palliative Care-A Review on Pharmacological Interventions. Cancers (Basel) 2021; 13:cancers13050985. [PMID: 33652866 PMCID: PMC7956665 DOI: 10.3390/cancers13050985] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Cancer related fatigue is a common and distressing symptom for patients with cancer during and after primary treatment, and also in the palliative phase of the disease trajectory. This review focuses on the pharmacological treatment of cancer related fatigue in patients with advanced or metastatic cancer. There are few high-quality studies performed in this setting, but both methylphenidate and corticosteroids might be used to relieve fatigue. Abstract Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large meta-analysis of interventions on fatigue focuses mostly on patients early in the disease trajectory, with only one tenth of included studies performed in palliative cohorts. The aim of this narrative review is therefore to present a background on CRF with focus on the palliative setting. A summary of recent randomized, controlled trials on pharmacological interventions on CRF in palliative care is presented, including studies on psychostimulants, corticosteroids, testosterone and melatonin. Interestingly, in several of these studies there was a positive and similar effect on fatigue in both the intervention and the placebo arm—indicating an important placebo effect for any pharmacological treatment. In addition, studies on dietary supplements and on pharmacological complementary medicines are discussed. To conclude, the evidence is still weak for using pharmacological treatments on CRF in palliative care patients—although methylphenidate and corticosteroids might be considered.
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Frikkel J, Beckmann M, De Lazzari N, Götte M, Kasper S, Hense J, Schuler M, Teufel M, Tewes M. Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months-a comparative study. Support Care Cancer 2021; 29:5127-5137. [PMID: 33608761 PMCID: PMC8295138 DOI: 10.1007/s00520-021-06020-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 01/28/2023]
Abstract
Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017
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Affiliation(s)
- J Frikkel
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Beckmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - N De Lazzari
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Götte
- Department of Pediatric Hematology/Oncology, Center for Child and Adolescent Medicine, University Hospital Essen, Essen, Germany
| | - S Kasper
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - J Hense
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany
| | - M Schuler
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.,German Cancer Consortium (DKTK), Partner Site University Hospital Essen, 45147, Essen, Germany
| | - M Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR-Klinikum Essen, 45147, Essen, Germany
| | - M Tewes
- West German Cancer Center Essen, Department of Medical Oncology, University Hospital Essen, 45147, Essen, Germany.
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Dunleavy L, Collingridge Moore D, Korfage I, Payne S, Walshe C, Preston N. What should we report? Lessons learnt from the development and implementation of serious adverse event reporting procedures in non-pharmacological trials in palliative care. BMC Palliat Care 2021; 20:19. [PMID: 33472621 PMCID: PMC7819235 DOI: 10.1186/s12904-021-00714-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 01/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background/aims Serious adverse event reporting guidelines have largely been developed for pharmaceutical trials. There is evidence that serious adverse events, such as psychological distress, can also occur in non-pharmaceutical trials. Managing serious adverse event reporting and monitoring in palliative care non-pharmaceutical trials can be particularly challenging. This is because patients living with advanced malignant or non-malignant disease have a high risk of hospitalisation and/or death as a result of progression of their disease rather than due to the trial intervention or procedures. This paper presents a number of recommendations for managing serious adverse event reporting that are drawn from two palliative care non-pharmacological trials. Methods The recommendations were iteratively developed across a number of exemplar trials. This included examining national and international safety reporting guidance, reviewing serious adverse event reporting procedures from other pharmacological and non-pharmacological trials, a review of the literature and collaboration between the ACTION study team and Data Safety Monitoring Committee. These two groups included expertise in oncology, palliative care, statistics and medical ethics and this collaboration led to the development of serious adverse event reporting procedures. Results The recommendations included; allowing adequate time at the study planning stage to develop serious adverse event reporting procedures, especially in multi-national studies or research naïve settings; reviewing the level of trial oversight required; defining what a serious adverse event is in your trial based on your study population; development and implementation of standard operating procedures and training; refining the reporting procedures during the trial if necessary and publishing serious adverse events in findings papers. Conclusions There is a need for researchers to share their experiences of managing this challenging aspect of trial conduct. This will ensure that the processes for managing serious adverse event reporting are continually refined and improved so optimising patient safety. Trial registration ACTION trial registration number: ISRCTN63110516 (date of registration 03/10/2014). Namaste trial registration number: ISRCTN14948133 (date of registration 04/10/2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00714-5.
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Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Faculty of Health and Medicine, Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK.
| | - Danni Collingridge Moore
- International Observatory on End of Life Care, Faculty of Health and Medicine, Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
| | - Ida Korfage
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | - Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Division of Health Research, Health Innovation One, Sir John Fisher Drive, Lancaster University, Lancaster, LA1 4AT, UK
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The Family Talk Intervention in palliative home care when a parent with dependent children has a life-threatening illness: A feasibility study from parents' perspectives. Palliat Support Care 2020; 19:154-160. [PMID: 32854809 DOI: 10.1017/s1478951520000735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE One of the main goals of the Family Talk Intervention (FTI) is to increase communication within families with dependent children about illness-related consequences and to support parenting. FTI is family-centered and includes six manual-based meetings led by two interventionists. This study aims to evaluate the feasibility of the FTI in terms of acceptability from the perspective of parents in families with dependent children where one parent receives specialized palliative home care. METHOD A descriptive design employing mixed methods was used to evaluate the FTI in specialized palliative home care. In total, 29 parents participated in interviews and responded to a questionnaire following FTI. Qualitative content analysis and descriptive statistics were used for analyses. RESULTS FTI responded to both the ill parent's and the healthy co-parent's expectations, and they recommended FTI to other families. Parents found the design of FTI to be well-structured and flexible according to their families' needs. Many parents reported a wish for additional meetings and would have wanted FTI to start earlier in the disease trajectory. Parents also would have wished for a more thorough briefing with the interventionists to prepare before the start. The importance of the interventionists was acknowledged by the parents; their professional competence, engagement, and support were vital for finding ways to open communication within the family. The FTI meetings provided them with a setting to share thoughts and views. Parents clearly expressed that they would never have shared thoughts and feelings in a similar way without the meetings. SIGNIFICANCE OF RESULTS According to parents, FTI was found acceptable in a palliative home care context with the potential to add valuable support for families with minor children when a parent is suffering from a life-threatening illness.
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Scaccabarozzi G, Amodio E, Riva L, Corli O, Maltoni M, Di Silvestre G, Turriziani A, Morino P, Pellegrini G, Crippa M. Clinical Care Conditions and Needs of Palliative Care Patients from Five Italian Regions: Preliminary Data of the DEMETRA Project. Healthcare (Basel) 2020; 8:healthcare8030221. [PMID: 32698477 PMCID: PMC7551071 DOI: 10.3390/healthcare8030221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/03/2023] Open
Abstract
In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients' needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.
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Affiliation(s)
| | - Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy;
| | - Luca Riva
- UOS Unità Cure Palliative Ospedaliere, ASST Lecco, 23900 Lecco, Italy;
| | - Oscar Corli
- Pain and Palliative Care Research Unit, Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, 20156 Milan, Italy;
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy;
| | | | - Adriana Turriziani
- Master Cure Palliative, Università Cattolica S.Cuore, 00168 Rome, Italy;
| | - Piero Morino
- UFC Coordinamento Aziendale Cure Palliative USL Toscana Centro, 50142 Firenze, Italy;
| | - Giacomo Pellegrini
- Fondazione Floriani, Via privata Nino Bonnet, 2-20154 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6261-1132
| | - Matteo Crippa
- Fondazione Floriani, Via privata Nino Bonnet, 2-20154 Milan, Italy;
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