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King DS, Coupland B, Mytton J, Speakman J, Lock A, Sanyal N, Nelms L, Rayner S, Nanton V, Dosanjh A, Patel P, Trudgill N. High early mortality after percutaneous liver biopsy in metastatic cancer: national analysis. BMJ Support Palliat Care 2024:spcare-2024-004936. [PMID: 39089725 DOI: 10.1136/spcare-2024-004936] [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: 04/17/2024] [Accepted: 05/21/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE The study aimed to assess outcomes in patients undergoing liver biopsy for metastatic cancer, focusing on mortality rates and chemotherapy following their biopsy. METHODS Hospital Episode Statistics data from 2010 to 2019 identified 30 992 patients with metastatic cancer who underwent percutaneous liver biopsy. Primary outcomes included 14-day and 30-day mortality rates, as well as the proportion receiving chemotherapy within 6 months. RESULTS 30 992 patients were studied (median age of 69 (IQR 59-74) years, 52% female). 28% underwent inpatient biopsy with 8% dying within 14 days and 26% within 30 days. Outpatient biopsies had lower mortality rates: 2.2% at 14 days and 8.6% at 30 days.30-day mortality was associated with: inpatient biopsy (OR 3.5 (95% CI 3.26 to 3.76)) and increasing comorbidity (Charlson score 1-4: 1.21 (95% CI 1.11 to 1.32)); but negatively with all ages under 70 (eg, for 18-29 years 0.35 (95% CI 0.20 to 0.63)) and biopsy at a radiotherapy centre (0.88 (95% CI 0.82 to 0.95)).46% of patients received chemotherapy within 6 months of biopsy (53% with outpatient biopsies but only 33% with inpatient biopsies). Receiving chemotherapy was associated with: all ages under 70 (eg, 18-29 years 3.3 (95% CI 2.62 to 5.30)), female sex (1.06 (95% CI 1.01 to 1.11)) and medium (1.13 (95% CI 1.04 to 1.22) and high (1.49 (95% CI 1.38 to 1.62)) volume liver biopsy providers; but negatively with inpatient biopsy (0.45 (95% CI 0.43 to 0.48)) and increasing comorbidity (Charlson score 1-4: 0.85 (95% CI 0.79 to 0.91)). CONCLUSIONS Mortality rates following liver biopsy for metastatic cancer are notably higher among patients undergoing emergency inpatient procedures. Clinicians should carefully weigh the risks and benefits of biopsy in elderly, comorbid or poor performance status patients. Multidisciplinary approaches involving palliative care may aid in decision-making for these patients.
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Affiliation(s)
| | - Benjamin Coupland
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jemma Mytton
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Speakman
- Department of Palliative Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anna Lock
- Department of Palliative Care, Sandwell & West Birmingham NHS Trust, West Bromwich, UK
| | - Nikhil Sanyal
- Department of Palliative Care, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Louisa Nelms
- Department of Palliative Care, Severn Hospice, Shrewsbury, UK
| | - Sophie Rayner
- St Lukes Hospice Plymouth, Plymouth, UK
- Department of Palliative Care, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Veronica Nanton
- Gibbet Hill Campus, University of Warwick, Health Sciences, Medical School Building, Coventry, UK
| | - Amandeep Dosanjh
- Department of Health Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Nigel Trudgill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Gastroenterology, Sandwell & West Birmingham NHS Trust, West Bromwich, UK
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2
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Lewis-Norman C, Vidrine J, Thistlethwayte E. Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services. Curr Opin Support Palliat Care 2024; 18:86-91. [PMID: 38652458 DOI: 10.1097/spc.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Adolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. RECENT FINDINGS Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. SUMMARY Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.
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3
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Beserra VDS, Brito C. [Difficult situations and feelings in palliative oncology care]. CAD SAUDE PUBLICA 2024; 40:e00116823. [PMID: 38359275 PMCID: PMC10876151 DOI: 10.1590/0102-311xpt116823] [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: 06/26/2023] [Revised: 08/28/2023] [Accepted: 09/29/2023] [Indexed: 02/17/2024] Open
Abstract
The act of caring for people in pain, shortness of breath, and imminent death on a daily basis can intensify difficult situations for health professionals. However, difficult situations are rarely discussed in the services and in the professional training process. This study aimed to analyze difficult situations and feelings that emerge from healthcare. This is a phenomenological and qualitative study based on 30 difficult situations of health professionals who work exclusively in palliative oncological care. The interviews were conducted from August to February 2020. The results show that the main difficulties were motivated by identification (when the professional recognizes similarities in the patient they are caring for), a bad death (with suffering), caring for young patients, the death of a mother with a small child, and when there was a divergence between what the professional proposed and the patient's choice. There was a relationship between types of difficult situations and professional category. The professionals expressed both unpleasant feelings (sadness, impotence, anguish, fear) and pleasant feelings (compassion, gratitude). The results show that the concealment of the dying process throughout the societies' development turned it into a taboo, causing distress even in those who work in palliative care. They also show an important subjective dimension of care, usually neglected, which generates suffering, but also resignification. To properly provide care, health professionals must find meaning in the work, made possible by the modification of the their internal mindset via experience, which generates transformation, new meaning, and knowledge from praxis.
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Affiliation(s)
| | - Claudia Brito
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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4
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George LS, Epstein RM, Akincigil A, Saraiya B, Trevino KM, Kuziemski A, Pushparaj L, Policano E, Prigerson HG, Godwin K, Duberstein P. Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis. J Gen Intern Med 2023; 38:1516-1525. [PMID: 36732436 PMCID: PMC10160244 DOI: 10.1007/s11606-022-08011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized. OBJECTIVE Conduct a review of qualitative studies to explicate whether and how psychological propensities could result in some physicians providing more intensive treatment than others. METHODS Systematic searches were conducted in five major electronic databases-MEDLINE ALL (Ovid), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), and Cochrane CENTRAL (Wiley)-to identify eligible studies (earliest available date to August 2021). Eligibility criteria included examination of a physician psychological factor as relating to end-of-life care intensity in advanced life-limiting illness. Findings from individual studies were pooled and synthesized using thematic analysis, which identified common, prevalent themes across findings. RESULTS The search identified 5623 references, of which 28 were included in the final synthesis. Seven psychological propensities were identified as influencing physician judgments regarding whether and when to withhold or de-escalate life-extending treatments resulting in higher treatment intensity: (1) professional identity as someone who extends lifespan, (2) mortality aversion, (3) communication avoidance, (4) conflict avoidance, (5) personal values favoring life extension, (6) decisional avoidance, and (7) over-optimism. CONCLUSIONS Psychological propensities could influence physician judgments regarding whether and when to de-escalate life-extending treatments. Future work should examine how individual and environmental factors combine to create such propensities, and how addressing these propensities could reduce physician-attributed variation in end-of-life care intensity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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5
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Vidal C, Romero I, Neto I. Malignant Peritoneal Mesothelioma: A Challenging Case for Palliative Care. Cureus 2022; 14:e27580. [PMID: 36059360 PMCID: PMC9428408 DOI: 10.7759/cureus.27580] [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] [Accepted: 07/29/2022] [Indexed: 11/05/2022] Open
Abstract
Malignant peritoneal mesothelioma (MPM) is a rare and very aggressive malignancy of serosal membranes, which typically presents with abdominal pain, distension, and ascites. Due to its rarity and nonspecific symptoms, it is usually diagnosed late, when the disease burden is extensive and the therapy is inevitably palliative. It represents a complex challenge for clinicians because the treatment options are very poor and the illness has a great impact on patients’ life. We present a complex case of a young patient with MPM who was admitted to our palliative care unit.
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Burgers V, van den Bent M, Darlington AS, Gualthérie van Weezel A, Compter A, Tromp J, Lalisang R, Kouwenhoven M, Dirven L, Harthoorn N, Troost-Heijboer C, Husson O, van der Graaf W. A qualitative study on the challenges health care professionals face when caring for adolescents and young adults with an uncertain and/or poor cancer prognosis. ESMO Open 2022; 7:100476. [PMID: 35533426 PMCID: PMC9271469 DOI: 10.1016/j.esmoop.2022.100476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022] Open
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7
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Younger E, Jones RL, den Hollander D, Soomers VLMN, Desar IME, Benson C, Young RJ, Oosten AW, de Haan JJ, Miah A, Zaidi S, Gelderblom H, Steeghs N, Husson O, van der Graaf WTA. Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study. ESMO Open 2021; 6:100258. [PMID: 34509803 PMCID: PMC8441156 DOI: 10.1016/j.esmoop.2021.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions. PATIENTS AND METHODS The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing health-related quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences. RESULTS One hundred and thirty-seven patients with advanced STS participated (UK: n = 72, the Netherlands: n = 65). Median age was 62 (27-79) years. Preference for extended LoL (n = 66, 48%) was slightly more common than preference for QoL (n = 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n = 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged ≥65 years) felt that QoL was equally or more important than LoL (P = 0.020). Decisional conflict was most common in patients who prioritised QoL (P = 0.024). Most patients preferred an active (n = 45, 33%) or collaborative (n = 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n = 104, 76%). CONCLUSIONS Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.
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Affiliation(s)
- E Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - D den Hollander
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - V L M N Soomers
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R J Young
- Academic Unit of Clinical Oncology, The University of Sheffield, Sheffield, UK
| | - A W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J J de Haan
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - A Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - S Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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8
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Labudde EJ, DeGroote NP, Ebelhar J, Massie AM, Allen KE, Castellino SM, Wasilewski-Masker K, Brock KE. Evaluating Palliative Opportunities Across the Age Spectrum in Children and Adolescent Patients with Cancer. J Adolesc Young Adult Oncol 2021; 11:402-409. [PMID: 34582272 DOI: 10.1089/jayao.2021.0081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent patients with cancer experience unique stressors due to their developmental stage, with increased physical, emotional, and social distress. Palliative care (PC) serves an important role in pediatric cancer care. We examined "palliative opportunities," or events during a patient's cancer course where subspecialty PC would be warranted and compared opportunities between adolescents and younger patients. Methods: Patients from a single center, 0-18 years of age at cancer diagnosis, who died from January 1, 2012, to November 30, 2017, were included. In this secondary analysis, patients were divided into cohorts based on age at diagnosis: 0-12 and 13-18 years. Demographic, disease, and treatment data were collected. Descriptive statistics and modeling were performed. Number, type, and timing of palliative opportunities and PC consultation timing and reason were evaluated across cohorts. Results: Of the 296 patients included for analysis, 27.7% were 13-18 years (82/296) at diagnosis. Frequency of palliative opportunities did not differ by age (median 7.0 [interquartile range 4.0 and 10.0] in both cohorts). PC consultation occurred in 36.5% (108/296), with neither rate nor timing differing by age group. PC consultations in adolescents were more often for symptom management (p = 0.0001). Adolescent patients were less likely to have a do-not-resuscitate order placed before death (61.0%, 50/82) compared to younger patients (73.8%, 158/214, p = 0.03). Conclusion: Adolescent patients with cancer did not experience more palliative opportunities than younger patients in this cohort, although they often have challenging psychological, family, and social stressors that were not identified. Incorporating additional palliative opportunities could enhance identification of stress and symptoms in adolescents with cancer such that PC could be timed to meet their needs.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Nicholas P DeGroote
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jonathan Ebelhar
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - A McCauley Massie
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristen E Allen
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sharon M Castellino
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Division of Pediatric Hematology/Oncology, Department of Pediatrics, Emory University, Atlanta, Georgia, USA.,Division of Pediatric Palliative Care, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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9
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Mattsson TO, Pottegård A, Jørgensen TL, Green A, Bliddal M. End-of-life anticancer treatment - a nationwide registry-based study of trends in the use of chemo-, endocrine, immune-, and targeted therapies. Acta Oncol 2021; 60:961-967. [PMID: 33651643 DOI: 10.1080/0284186x.2021.1890332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anticancer treatments near the end of a patient's life should generally be avoided, as it leaves the patient with no significant anticancer effect but increases the risk of severe side effects. We described the pattern of all end-of-life anticancer treatment in a population of Danish cancer patients. METHODS Using the Danish national health registries, we identified all patients deceased due to cancer 2010-2015. Anticancer treatment registered in the last 30 days of life was categorized as end-of-life treatment. Predictors of such treatment were investigated using logistic regression models. RESULTS We identified 42,277 patients (median age 70 years) of whom 16% received end-of-life anticancer treatment. This proportion did not change during the study period (p = .09). Chemotherapy alone was the most frequent treatment, accounting for 78% of all end-of-life treatment in 2010, decreasing to 71% in 2015. In contrast, end-of-life use of immunotherapy, targeted therapy and endocrine therapy increased during the study period. Breast cancer as index cancer was associated with the highest frequency of end-of-life treatment (23%), followed by malignant melanoma (21%), and prostate cancer (18%). Factors associated with lower odds for end-of-life treatment were female sex, older age, high burden of comorbidity, and being diagnosed >6 months prior to death. CONCLUSIONS We found a stable overall rate at 16% of patients receiving anticancer treatment within one month prior to death in this nationwide sample of cancer deaths. Further research is needed to assess whether this level of end-of-life treatment is justified or reflects inappropriate use.
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Affiliation(s)
- Thea Otto Mattsson
- Department of Oncology, Odense University Hospital, Odense, Denmark
- AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Department of Public Health, Division of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Green
- OPEN – Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Mette Bliddal
- OPEN – Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
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10
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Nurses' involvement in end-of-life discussions with incurable cancer patients and family caregivers: An integrative review. Palliat Support Care 2021; 20:570-581. [PMID: 33952373 DOI: 10.1017/s1478951521000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM To review current evidence of nurses' involvement in end-of-life discussions with incurable cancer patients and their family caregivers. DESIGN We conducted a systematic integrative review in accordance with PRISMA guidelines: PROSPERO, registration number: CRD42020186204. DATA SOURCES CINAHL, Medline, PsycInfo, Embase. We searched for primary research between 2010 and 2020. RESULTS Of 3,271 references, we found 15 eligible articles: qualitative (n = 12) and quantitative (n = 3). The studies focused on oncology nurses' perspective of involvement in end-of-life discussions. The data analysis resulted in four overall themes: (1) Nursing roles; the advocating, supporting, and reframing roles, and an undefined task, for example in medical consultations, (2) Trust building, (3) Nurse competences, and (4) Medical issues. SIGNIFICANCE OF RESULTS The nurses have several roles in end-of-life discussions, but insufficient competencies to be involved in that kind of discussions, for example to involve and communicate with families. The findings implicate an educational need among the nurses. However, it also points toward an organizational change in the outpatient clinics, for example that end-of-life discussions follow a more structured approach, are offered in a scheduled manner, and that nurses invite the family caregivers to attend.
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11
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Avery J, Mosher PJ, Kassam A, Srikanthan A, D'Agostino N, Zimmermann C, Castaldo Y, Aubrey R, Rodrigues CM, Thavaratnam A, Samadi M, Al-Awamer A, Gupta A. Young Adult Experience in an Outpatient Interdisciplinary Palliative Care Cancer Clinic. JCO Oncol Pract 2020; 16:e1451-e1461. [PMID: 32903156 DOI: 10.1200/op.20.00161] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Young adults (YAs; defined as 18-39 years of age) with advanced cancer are a group for whom standardized age-appropriate palliative care has not been established. The purpose of this study was to explore the YA experience and perceptions of palliative care in an outpatient interdisciplinary palliative care clinic for this population. PATIENTS AND METHODS Using an interpretive descriptive design, semistructured interviews were conducted with 12 YAs with advanced cancer who were being seen jointly by a palliative care physician and psychiatrist in an ambulatory palliative care clinic. Interviews explored participants' understanding and experiences of receiving palliative care. Six family members were also interviewed to build on the YA experience. Data collection and analysis occurred concurrently, drawing on the constructivist grounded theory method to analyze the data. RESULTS Participants described being referred to and seen in the interdisciplinary palliative care clinic as a conflicting and at times difficult experience because of the feeling of being categorized as palliative as YAs. Even so, there were key aspects associated with the specific palliative care approach that allowed YAs to cope with this new label, leading to a beneficial experience, specifically: provided YAs with time and space to explore the experience of having cancer at a younger age, created repeat opportunities to talk openly with people who "got it," and highlighted the importance of including family support in the care of YAs. CONCLUSION YAs who were referred to the interdisciplinary palliative care clinic struggled with the category of palliative care but also found the care they received beneficial. Findings provide an approach to palliative care tailored to YAs with advanced cancer.
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Affiliation(s)
- Jonathan Avery
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Pamela J Mosher
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Alisha Kassam
- Division of Medical Oncology and Hematology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Norma D'Agostino
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yan Castaldo
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rachel Aubrey
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Caroline M Rodrigues
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Adrian Thavaratnam
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Mahsa Samadi
- Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ahmed Al-Awamer
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abha Gupta
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Adolescent and Young Adult Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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12
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De Clercq E, Rost M, von der Weid N, Ansari M, Elger BS. To be or not to be in the social media arena? The perspective of healthcare providers working within adolescent and young adult oncology in Switzerland. Int J Adolesc Med Health 2020; 34:417-429. [PMID: 32860667 DOI: 10.1515/ijamh-2020-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022]
Abstract
Background Given that social media is quickly penetrating clinical practice, it is essential to explore how these technologies can be used to improve patient-centered care. This is particularly important for healthcare professionals caring for adolescents and young adults (AYA), amid whom the use of social media is nearly universal and whose medical and psychosocial needs are often underestimated by the pediatric or adult oncology settings in which they are treated. Objectives To examine the perspectives of various medical professionals on the emerging role of social media in AYA oncology. Methods Three focus groups were performed with Swiss healthcare professionals involved in the care of AYA patients with cancer. The focus groups were analyzed using thematic coding. Results Healthcare professionals caring for AYA cancer patients in Switzerland are reluctant to step into the social media sphere because they find it difficult to navigate professional boundaries in an unfamiliar space where different contexts collapse. Nurses and younger healthcare professionals who tend to have a more intimate relationship with AYA, often lack virtual mentorship to know how to maintain online professionalism. Adolescents and young adults cancer-related social media presence was unknown to our participants which resulted in missed occasions to inform, educate and care for this often underserved population of cancer patients. Conclusions More practical guidance is needed to help healthcare professionals with how to integrate social media into clinical practice. Setting up fruitful collaborations between medical institutions and existing AYA support groups online might be the best way forward.
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Affiliation(s)
- Eva De Clercq
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
| | - Michael Rost
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
| | | | - Marc Ansari
- Hôpitaux Universitaires de Genève, Département de l'Enfant et de l'Adolescent, Onco-hématologie pédiatrique, Genève, Switzerland
| | - Bernice S Elger
- University of Basel, Institute for Biomedical Ethics, Basel, Switzerland
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13
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Lockwood BJ, Ntukidem OL, Ehrman SE, Schnell PM, Klemanski DL, Bhatnagar B, Lustberg M. Palliative Care Referral Patterns for Adolescent and Young Adult Patients at a Comprehensive Cancer Center. J Adolesc Young Adult Oncol 2020; 10:109-114. [PMID: 32706607 DOI: 10.1089/jayao.2020.0081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Palliative care (PC) serves a valuable role throughout the disease trajectory for adolescents and young adults (AYAs) living with cancer. A 3-year retrospective chart review was performed to characterize AYA PC referral patterns in patients aged 18-39 years to identify strategies for improving PC access. Despite known benefits, AYA referrals to PC during oncologic treatment occurred only for a small percentage of eligible patients (8.4%), largely occurred in the inpatient setting (73%), and were more likely in specific cancer types with high symptom burden and/or poor survival, with the greatest penetrance noted in lung cancer (51%).
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Affiliation(s)
- Bethany J Lockwood
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Olanipekun L Ntukidem
- Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Sarah E Ehrman
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Patrick M Schnell
- Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA
| | - Dori L Klemanski
- Patient Services Administration, The Ohio State University, Columbus, Ohio, USA
| | - Bhavana Bhatnagar
- Division of Hematology, and The Ohio State University, Columbus, Ohio, USA
| | - Maryam Lustberg
- Division of Medical Oncology, The Ohio State University, Columbus, Ohio, USA
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14
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Avery J, Geist A, D'Agostino NM, Kawaguchi SK, Mahtani R, Mazzotta P, Mosher PJ, Al-Awamer A, Kassam A, Zimmermann C, Samadi M, Tam S, Srikanthan A, Gupta A. "It's More Difficult…": Clinicians' Experience Providing Palliative Care to Adolescents and Young Adults Diagnosed With Advanced Cancer. JCO Oncol Pract 2019; 16:e100-e108. [PMID: 31765276 DOI: 10.1200/jop.19.00313] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYAs; age 15-39 years) with advanced cancer are a population in whom quality of life is uniquely affected because of their stage of life. However, training focused on palliative care for AYAs is not routinely provided for health care providers (HCPs) in oncology. This study aims to explore the experiences of HCPs involved in introducing and providing palliative care caring for AYAs with advanced cancer and their families to understand the unique challenges HCPs experience. METHODS Using a qualitative descriptive design, semistructured interviews were conducted with medical and radiation oncologists, palliative care physicians, psychiatrists, and advanced practice nurses involved in caring for AYAs diagnosed with advanced cancer (N = 19). Interviews were transcribed verbatim and analyzed using thematic analysis in combination with constant comparative analysis and theoretical sampling. RESULTS There were 19 participants, 9 men and 10 women, with a median age of 45 years (range, 24-67 years). Six were palliative care physicians, 5 medical oncologists, 4 nurse practitioners, and 2 each radiation oncologists and psychiatrists. Overall, participants perceived the provision of palliative care for AYAs to be more difficult compared with older adults. Four themes emerged: (1) challenges helping AYAs/families to engage in and accept palliative care, (2) uncertainty regarding how to involve the family, (3) HCP sense of tragedy, and (4) HCP sense of emotional proximity. CONCLUSION Findings from this study support the development of dedicated training for HCPs involved in palliative care for AYA.
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Affiliation(s)
| | - Arielle Geist
- University Health Network, Toronto, Ontario, Canada.,McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Paolo Mazzotta
- Sinai Health System, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Pamela J Mosher
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Ahmed Al-Awamer
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Alisha Kassam
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada.,Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Camilla Zimmermann
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
| | - Mahsa Samadi
- University Health Network, Toronto, Ontario, Canada
| | - Seline Tam
- University Health Network, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Abha Gupta
- University Health Network, Toronto, Ontario, Canada.,University of Toronto, Toronto, Canada
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15
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McCaughan D, Roman E, Smith AG, Garry AC, Johnson MJ, Patmore RD, Howard MR, Howell DA. Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study. Eur J Oncol Nurs 2019; 39:70-80. [PMID: 30850141 PMCID: PMC6417764 DOI: 10.1016/j.ejon.2019.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/04/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Patients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients' places of care and death. METHOD Qualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach. RESULTS Five inter-related factors were identified as contributing to the likelihood of patients' receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home. CONCLUSIONS Hospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.
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Affiliation(s)
- Dorothy McCaughan
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Alexandra G Smith
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
| | - Anne C Garry
- Department of Palliative Care, York Hospital, York, YO31 8HE, UK.
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, HU6 7RX, UK.
| | - Russell D Patmore
- Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, HU16 5JQ, UK.
| | - Martin R Howard
- Department of Haematology, York Hospital, York, YO31 8HE, UK.
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, University of York, York, YO10 5DD, UK.
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16
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Sarradon-Eck A, Besle S, Troian J, Capodano G, Mancini J. Understanding the Barriers to Introducing Early Palliative Care for Patients with Advanced Cancer: A Qualitative Study. J Palliat Med 2019; 22:508-516. [PMID: 30632886 DOI: 10.1089/jpm.2018.0338] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Palliative care is often underutilized or initiated late in the course of life-threatening illness. Randomized clinical Early Palliative Care (EPC) trials provide an opportunity for changing oncologists' perceptions of palliative care and their attitudes to referring patients to palliative care services. Aim: To describe French oncologists' perceptions of EPC and their effects on referral practices before a clinical EPC trial was launched. Design: A qualitative study involving semistructured face-to-face interviews. The data were analyzed using the Grounded Theory coding method. Setting/Participants: Thirteen oncologists and 19 palliative care specialists (PCSs) working at 10 hospitals all over France were interviewed. Most of them were involved in clinical EPC trials. Results: The findings suggest that referral to PCSs shortly after the diagnosis of advanced cancer increases the terminological barriers, induces avoidance patterns, and makes early disclosure of poor prognosis harder for oncologists. This situation is attributable to the widespread idea that palliative care means terminal care. In addition, the fact that the EPC concept is poorly understood increases the confusion between EPC and supportive care. Conclusion: Defining the EPC concept more clearly and explaining to health professionals and patients what EPC consists of and what role it is intended to play, and the potential benefits of palliative care services could help to overcome the wording barriers rooted in the traditional picture of palliative care. In addition, training French oncologists how to disclose "bad news" could help them cope with the emotional issues involved in referring patients to specialized palliative care.
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Affiliation(s)
- Aline Sarradon-Eck
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,2 Institut Paoli-Calmettes, Cancer, Biomedicine & Society, Marseille, France
| | - Sylvain Besle
- 1 Aix Marseille University, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health & Analysis of Medical Information, Marseille, France.,3 Drug Development Department (DITEP), Gustave Roussy, University Paris-Sud, University Paris-Saclay, Villejuif, France
| | - Jaïs Troian
- 4 Aix-Marseille University, Psychologie, Marseille, France
| | - Géraldine Capodano
- 5 Institut Paoli-Calmettes, Département de Soins de Support et Palliatifs, Marseille, France
| | - Julien Mancini
- 6 Aix-Marseille University, APHM, INSERM, IRD, SESSTIM, Economics and Social Science Applied to Health and Analysis of Medical Information, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
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