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Tonetto IFDA, Stabile AM, Kobayasi DY, de Cássia Quaglio R, de Souza AC, Bolela F. Management of Infections in Palliative Care Patients at the End-of-Life and Active Process of Death: A Brazilian Retrospective Study. Palliat Med Rep 2024; 5:324-330. [PMID: 39144136 PMCID: PMC11319859 DOI: 10.1089/pmr.2024.0005] [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: 05/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background There is a lack of specific studies on the management of infections in patients receiving palliative care (PC) in the final stages of life and during the active process of death, related to specific nursing care. There is clinical and social importance as patients in PC represent a vulnerable population, and adequate management of infections is crucial to improve quality of life and the experience of comfort. Objective This study analyzed how infections are managed in patients undergoing PC at the end-of-life and in the active process of death in two hospital health services. Design This is an observational, analytical, and retrospective study. Settings Data collection took place in two hospitals that assist individuals who are hospitalized under PC, located in Brazil, in a city in the interior of the state of São Paulo. Measurements and Results The sample consisted of 113 medical records, in which the oncological diagnosis was the most prevalent. There was a predominance of infection diagnoses based on the patient's clinical symptoms, the main focus being the pulmonary, in individuals at the end-of-life. The management of infection in the study sample occurred through care and procedures that generate physical discomfort, however aiming at relieving symptoms. Such findings must be documented, as they invite us to reflect on our practical attitudes and what it means to be comfortable for these people, making it possible to incorporate this information into the design of interventions focused on enhancing the experience of comfort.
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Affiliation(s)
| | - Angelita Maria Stabile
- Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto—Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Dieyeni Yuki Kobayasi
- Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto—Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Rita de Cássia Quaglio
- Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto—Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Ana Carolina de Souza
- Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto—Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Fabiana Bolela
- Enfermagem Fundamental, Escola de Enfermagem de Ribeirão Preto—Universidade de São Paulo, Ribeirão Preto, Brazil
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Pitzer S, Kutschar P, Paal P, Mülleder P, Lorenzl S, Wosko P, Osterbrink J, Bükki J. Barriers for Adult Patients to Access Palliative Care in Hospitals: A Mixed Methods Systematic Review. J Pain Symptom Manage 2024; 67:e16-e33. [PMID: 37717708 DOI: 10.1016/j.jpainsymman.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Access to palliative care services is variable, and many inpatients do not receive palliative care. An overview of potential barriers could facilitate the development of strategies to overcome factors that impede access for patients with palliative care needs. AIM To review the current evidence on barriers that impair, delay, or prohibit access to palliative care for adult hospital inpatients. DESIGN A mixed methods systematic review was conducted using an integrated convergent approach and thematic synthesis (PROSPERO ID: CRD42021279477). DATA SOURCES The Cochrane Library, MEDLINE, CINAHL, and PsycINFO were searched from 10/2003 to 12/2020. Studies with evidence of barriers for inpatients to access existing palliative care services were eligible and reviewed. RESULTS After an initial screening of 3,359 records and 555 full-texts, 79 studies were included. Thematic synthesis yielded 149 access-related phenomena in 6 main categories: 1) Sociodemographic characteristics, 2) Health-related characteristics, 3) Individual beliefs and attitudes, 4) Interindividual cooperation and support, 5) Availability and allocation of resources, and 6) Emotional and prognostic challenges. While evidence was inconclusive for most socio-demographic factors, the following barriers emerged: having a noncancer condition or a low symptom burden, the focus on cure in hospitals, nonacceptance of terminal prognosis, negative perceptions of palliative care, misleading communication and conflicting care preferences, lack of resources, poor coordination, insufficient expertise, and clinicians' emotional discomfort and difficult prognostication. CONCLUSION Hospital inpatients face multiple barriers to accessing palliative care. Strategies to address these barriers need to take into account their multidimensionality and long-standing persistence.
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Affiliation(s)
- Stefan Pitzer
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria.
| | - Patrick Kutschar
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Piret Paal
- Institute of Palliative Care (P.P., S.L.), Paracelsus Medical University, Salzburg, Austria
| | - Patrick Mülleder
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Institute of Palliative Care (P.P., S.L.), Paracelsus Medical University, Salzburg, Austria
| | - Paulina Wosko
- Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute) (P.W.), Vienna, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Johannes Bükki
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria; Helios-Kliniken Schwerin (J.B.), Center for Palliative Medicine, Schwerin, Germany
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Almeida LKR, Avelino-Silva TJ, de Lima E Silva DC, Campos BA, Varela G, Fonseca CMB, Amorim VL, Piza FMDT, Aliberti MJ, Degani-Costa LH. Palliative care in Hospitalized Middle-Aged and Older Adults With COVID-19. J Pain Symptom Manage 2022; 63:680-688. [PMID: 35017017 PMCID: PMC8743276 DOI: 10.1016/j.jpainsymman.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/06/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
Abstract
CONTEXT As COVID-19 overwhelms health systems worldwide, palliative care strategies may ensure rational use of resources while safeguarding patient comfort and dignity. OBJECTIVE To describe palliative care practices in hospitalized middle-aged and older adults in two of the largest COVID-19 treatment centers in Sao Paulo, Brazil. METHODS Retrospective cohort. Eligible patients were those aged 50 years or older hospitalized between March and May 2020 with a laboratory confirmation of SARS-CoV-2 infection. Palliative care implementation was defined as present if medical notes indicated a decision to limit escalation of life support measures, or when opioids or sedatives were prescribed for palliative management of symptoms. RESULTS We included 1162 participants (57% male, median 65 years). Overall, 21% were frail and 54% were treated in intensive care units, but only 17% received palliative care. Stepwise logistic regression demonstrated that age ≥80 years, dementia, history of stroke or cancer, frailty, having a PaO2/FiO2<200 or a C-reactive protein ≥150mg/dL at admission predicted palliative care implementation. Patients placed under palliative care stayed longer (13 vs.11 days) and were more likely to die in hospital (86 vs.27%). They also spent more days in ICU and received vasoactive drugs, hemodialysis, and invasive ventilation more frequently. CONCLUSIONS One in five middle-aged and older adults hospitalized with COVID-19 received palliative care in our cohort. Patients who were very old, multimorbid, frail, and had severe COVID-19 were more likely to receive palliative care. However, it was often delayed until advanced and invasive life support measures had already been implemented.
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Affiliation(s)
- Lyna Kyria Rodrigues Almeida
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil
| | - Débora Carneiro de Lima E Silva
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Bruna A Campos
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Gabriela Varela
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Cristina Mara Baghelli Fonseca
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Victor Lp Amorim
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil
| | - Felipe Maia de Toledo Piza
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil
| | - Marlon Jr Aliberti
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina (L.K.R.D.A., T.J.A.S., M.J.A.), Universidade de São Paulo, Sao Paulo, Brazil
| | - Luiza Helena Degani-Costa
- Hospital Municipal Dr. Moysés Deutsch (L.K.R.D.A, D.C.D.L.S., B.A.C., G.V., C.M.B.F., V.L.A., F.M.D.T.P., L.H.D.C.) Sao Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein (T.J.A.S., V.L.A., L.H.D.C.), Sao Paulo, Brazil.
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