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Hedman C, Fürst P, Strang P, Schelin MEC, Lundström S, Martinsson L. Pain prevalence and pain relief in end-of-life care - a national registry study. BMC Palliat Care 2024; 23:171. [PMID: 39004730 PMCID: PMC11247729 DOI: 10.1186/s12904-024-01497-1] [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: 04/11/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Despite pain control being a top priority in end-of-life care, pain continues to be a troublesome symptom and comprehensive data on pain prevalence and pain relief in patients with different diagnoses are scarce. METHODS The Swedish Register of Palliative Care (SRPC) was used to retrieve data from 2011 to 2022 about pain during the last week of life. Data were collected regarding occurrence of pain, whether pain was relieved and occurrence of severe pain, to examine if pain differed between patients with cancer, heart failure, chronic obstructive pulmonary disease (COPD) and dementia. Binary logistic regression models adjusted for sex and age were used. RESULTS A total of 315 000 patients were included in the study. Pain during the last week of life was more commonly seen in cancer (81%) than in dementia (69%), heart failure (68%) or COPD (57%), also when controlled for age and sex, p < 0.001. Severe forms of pain were registered in 35% in patients with cancer, and in 17-21% in non-cancer patients. Complete pain relief (regardless of pain intensity) was achieved in 73-87% of those who experienced pain, depending on diagnosis. The proportion of patients with complete or partial pain relief was 99.8% for the whole group. CONCLUSIONS The occurrence of pain, including severe pain, was less common in patients with heart failure, COPD or dementia, compared to patients with cancer. Compared with cancer, pain was more often fully relieved for patients with dementia, but less often in heart failure and COPD. As severe pain was seen in about a third of the cancer patients, the study still underlines the need for better pain management in the imminently dying. TRIAL REGISTRATION No trial registration was made as all patients were deceased and all data were retrieved from The Swedish Register of Palliative Care database.
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Affiliation(s)
- Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Solna (L1:00), Stockholm, SE-171 76, Sweden.
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden.
- Department of Clinical Sciences Lund, Lund University, BMC I12, Lund, SE-221 84, Sweden.
| | - Per Fürst
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Huddinge, SE-141 83, Sweden
| | - Peter Strang
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Anna Steckséns gata 30A, Stockholm, D2:04, SE-171 64, Sweden
| | - Maria E C Schelin
- Department of Clinical Sciences Lund, Lund University, BMC I12, Lund, SE-221 84, Sweden
| | - Staffan Lundström
- R & D Department, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm, SE-112 19, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Anna Steckséns gata 30A, Stockholm, D2:04, SE-171 64, Sweden
| | - Lisa Martinsson
- Department of Diagnostics and Intervention Oncology, Umeå University, Umeå, SE-901 87, Sweden
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Schukow C, Alawy B. Advocating for Training in End-Of-Life Conversations With Seriously Ill Patients During Residency. Am J Hosp Palliat Care 2024; 41:726-729. [PMID: 37845789 DOI: 10.1177/10499091231208388] [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: 10/18/2023] Open
Abstract
According to section IV.B.1.e of common residency program requirements from the Accreditation Council for Graduate Medical Education (ACGME), "[r]esidents must learn to communicate with patients and families to partner with them to assess their care goals, including, when appropriate, end-of-care [EOL] goals". EOL conversations are frequently appropriate for patients suffering from serious, life-threatening diseases (ie, terminal illness) or otherwise chronic health conditions with poor disease trajectories. These conversations are often followed with services and care from palliative medicine or hospice specialists depending on patients' projected prognoses (ie, 6 months or less). The focus of this patient-centered care, then, is on relieving patient and caregiver suffering, establishing clear treatment goals, and managing the physical, psychosocial, and spiritual burdens of disease. Although palliative medicine and hospice care have been shown to reduce health care costs and improve the overall care of patients who require these services, recent literature still suggests a gap in training programs being able to provide effective, educational strategies to their trainees regarding the appropriate and competent delivery of EOL conversations. Herein, this commentary will provide a discussion on what EOL is, palliative vs hospice care indications, and address current literature regarding EOL exposure within training programs while offering our personal insight and advocacy on the manner.
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Affiliation(s)
- Casey Schukow
- Department of Pathology, Corewell Health's Beaumont Hospital, Royal Oak, MI, USA
| | - Bilal Alawy
- Department of Graduate Medical Education, ProMedica Monroe Regional Hospital, Monroe, MI, USA
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Wang L, Li Y, Zhao R, Li J, Gong X, Li H. Development and Validation of the Home Hospice Care Needs Questionnaire for the Dying Old Adult (HHCNQ-DE) in Mainland China. Am J Hosp Palliat Care 2023:10499091231223486. [PMID: 38114232 DOI: 10.1177/10499091231223486] [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: 12/21/2023] Open
Abstract
Context: Home hospice needs assessment is the key to the development of home hospice services. Therefore, there is a need to develop assessment tools in mainland China to meet the comprehensive needs of the old adult at the end of life. Objective: To develop and validate a tool to assess Chinese mainland palliative care needs of the dying old adult at home. Methods: Using the Harmony Nursing Theory as a theoretical framework, through reference to the China home hospice care needs scale, literature research, in-depth conversations with the dying old adult, and group discussions among members of the research team, 43 original questionnaire items were preliminarily drafted. A 31-item predictive questionnaire was formed through 2 rounds of expert review and small sample testing. From April to September 2023, 199 old adult at the end of life at home in Jinzhou, Liaoning Province were investigated to determine the reliability and validity of the questionnaire. Results: The final questionnaire included 31 items. Exploratory factor analysis extracted 5 common factors, and the cumulative variance contribution rate was 68.811%; the Cronbach's alpha coefficient of the total questionnaire was 0.832, and the re-test reliability was .806; the content validity index of the questionnaire was 0.982, and the content validity index of the items was 0.83-1.00. Conclusion: The construction method of the HHCNQ-DE is scientific and reliable, with good reliability and validity, and it can be used as a tool to measure the needs of home hospice care in mainland China in the future.
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Affiliation(s)
- Lei Wang
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yaru Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Rui Zhao
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jiangxu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Xiangru Gong
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
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Hamano J, Shinjo T, Fukumoto K, Kodama M, Kim H, Otomo S, Masumoto S, Hashimoto K, Matsuki T, Hisajima K, Miyata N, Suzuki R, Yokoya S, Miyake K, Takayanagi R, Shimizu M, Kataoka Y, Taira H, Ozone S, Takahashi H, Kizawa Y. Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study. J Prim Care Community Health 2023; 14:21501319231221431. [PMID: 38131120 DOI: 10.1177/21501319231221431] [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: 12/23/2023] Open
Abstract
INTRODUCTION/OBJECTIVES There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. METHODS We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate). RESULTS In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009). CONCLUSIONS The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.
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Affiliation(s)
- Jun Hamano
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | | | - Maiko Kodama
- University of Fukui Hospital, Yoshida-gun, Fukui, Japan
| | - Hongja Kim
- Tottori University, Yonago, Tottoti, Japan
| | - Sen Otomo
- Seimeikan clinic, Sapporo, Hokkaido, Japan
| | - Shoichi Masumoto
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Tsukuba Central Hospital, Tsukuba, Ibaraki, Japan
| | | | | | | | | | | | - Shoji Yokoya
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Kitaibaraki Center for Family Medicine, Kitaibaraki, Ibaraki, Japan
| | | | | | | | - Yoshihiro Kataoka
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Sachiko Ozone
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Yoshiyuki Kizawa
- Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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