-
Biomedicine & Pharmacotherapy =... Dec 2020Individual response to medication depends on several factors (age, gender, body weight, general clinical condition, genetics, diet, hydration status, comorbidities,...
Individual response to medication depends on several factors (age, gender, body weight, general clinical condition, genetics, diet, hydration status, comorbidities, co-administered drugs and their mode of administration, smoking, alcohol overuse, environmental factors, e.g. sunlight) that may contribute to adverse drug reactions even at therapeutic doses. Patients in palliative care are at increased risk of these reactions. Unwanted drug effects diminish the quality of life and may lead to a suboptimal dying process. Haloperidol is one of the three most commonly used drugs in palliative care and the most commonly employed typical antipsychotic. It has also been recommended for inclusion into the palliative care emergency kit of home care teams. As such, it is important to be fully conversant with the indications, benefits, and risks of haloperidol, especially in the context of palliative care.
Topics: Antipsychotic Agents; Haloperidol; Humans; Palliative Care; Quality of Life; Risk Factors
PubMed: 33068931
DOI: 10.1016/j.biopha.2020.110772 -
JAMA Surgery Feb 2016Inpatient palliative care improves symptom management and patient satisfaction with care and reduces hospital costs in seriously ill patients. However, the role of... (Review)
Review
IMPORTANCE
Inpatient palliative care improves symptom management and patient satisfaction with care and reduces hospital costs in seriously ill patients. However, the role of palliative care in the treatment of patients undergoing surgery (surgical patients) remains poorly defined.
OBJECTIVE
To characterize the content, design, and results of interventions to improve access to palliative care or the quality of palliative care for surgical patients.
EVIDENCE REVIEW
This systematic review was conducted according to PRIMSA guidelines. Articles were identified through searches of PubMed, PsycINFO, EMBASE, and CINAHL as well as manual review of references. Eligible articles included experimental, quasi-experimental, and observational studies published in English from January 1, 1994, through October 31, 2014, in which patient outcomes of palliative care interventions for adult surgical patients were reported. Data on the study setting, design, intervention, participants, and results were extracted from the final study set and analyzed from December 22, 2014, to February 7, 2015.
FINDINGS
A total of 3838 abstracts were identified and screened by 2 reviewers, 77 articles were reviewed in full text, and 25 articles (22 unique interventions involving 8575 unique patients) met the study criteria. Interrater agreement was good (κ = 0.78). Nine single-institution retrospective cohort studies, 7 single-institution prospective cohort studies, 7 single-institution randomized clinical studies, and 2 multicenter randomized clinical studies were included. Nineteen of the 23 single-site studies were performed at academic hospitals. Given the heterogeneity of study methods and measures, meta-analysis was not possible. Preoperative decision-making interventions were associated with decreased mortality in 4 studies. Three studies reported improved quality of communication; 4, improved symptom management; and 7, decreased use of health care resources and decreased cost. However, many studies were small, performed in academic settings, and methodologically flawed and did not measure clinically meaningful outcomes.
CONCLUSIONS AND RELEVANCE
The sparse evidence regarding interventions to introduce or improve palliative care for surgical patients is further limited by methodologic flaws. Rigorous evaluations of standardized palliative care interventions measuring meaningful patient outcomes are needed.
Topics: Adult; Humans; Palliative Care; Surgical Procedures, Operative
PubMed: 26606747
DOI: 10.1001/jamasurg.2015.3625 -
Reviews on Recent Clinical Trials 2016To assess the role of early palliative care in patients with advanced oncologic and non-oncologic chronic diseases. (Review)
Review
BACKGROUND
To assess the role of early palliative care in patients with advanced oncologic and non-oncologic chronic diseases.
METHODS
A qualitative systematic review of literature was performed. All the randomized phase III trials comparing early, simultaneous palliative care and standard care in patients with advanced oncologic and non-oncologic diseases were considered eligible and included into the analysis. The outcomes were classified into 6 classes: quality of life, symptoms control, overall survival, quality of care, patients' and caregivers' satisfaction, and costs of the assistance.
RESULTS
Twelve papers reporting the data of 9 trials were considered eligible and included into the analysis. Two nonrandomized trials were also included into the selection because of the methods used by the authors. The early, simultaneous approach was reported to improve quality of life in two out of 7 papers, symptoms control in 1 out of 5 papers, overall survival in 2 out of 3 papers, quality of care in 5 out of 8 papers, patients' or caregivers' satisfaction in 3 out of 4 papers; and to reduce the costs of assistance in 2 out of 3 papers.
CONCLUSION
Early palliative care improves the main outcomes of the assistance in patients with advanced oncologic and non-oncologic chronic diseases. The available data are probably enough to consider early palliative cares a novel standard of care in these groups of patients.
Topics: Chronic Disease; Humans; Neoplasms; Palliative Care; Quality of Health Care
PubMed: 26464077
DOI: 10.2174/1574887110666151014141650 -
Cancer Control : Journal of the Moffitt... Oct 2015Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in... (Review)
Review
BACKGROUND
Many of the world's population live in rural areas. However, access and dissemination of the advances taking place in the field of palliative care to patients living in rural areas have been limited.
METHODS
We searched 2 large databases of the medical literature and found 248 relevant articles; we also identified another 59 articles through networking and a hand search of reference lists. Of those 307 articles, 39 met the inclusion criteria and were grouped into the following subcategories: intervention (n = 4), needs assessment (n = 2), program planning (n = 3), program evaluation (n = 4), education (n = 7), financial (n = 8), and comprehensive/systematic literature reviews (n = 11).
RESULTS
We synthesized the current state of rural palliative care research and practice to identify important gaps for future research. Studies were conducted in the United States, Australia, Canada, Africa, Sweden, and India. Two randomized control trials were identified, both of which used telehealth approaches and had positive survival outcomes. One study demonstrated positive patient quality of life and depression outcomes.
CONCLUSIONS
Research to guide rural palliative care practice is sparse. Approaches to telehealth, community- academic partnerships, and training rural health care professionals show promise, but more research is needed to determine best practices for providing palliative care to patients living in rural settings.
Topics: Humans; Palliative Care; Quality of Life; Randomized Controlled Trials as Topic; Rural Population
PubMed: 26678972
DOI: 10.1177/107327481502200411 -
Omega Jun 2023To review which are the most influential variables in achieving levels of psychological well-being at the end of life and to verify whether, as certain studies suggest,...
OBJECTIVE
To review which are the most influential variables in achieving levels of psychological well-being at the end of life and to verify whether, as certain studies suggest, spirituality, resilience and social support are the pillars on which the psychological well-being construct is based.
METHOD
A systematic search through the Scopus, Pubmed and PsycInfo electronic databases was carried out using keywords such as: "wellbeing" OR "psychological-well-being" AND "resilience" AND "spirituality" AND "social support" AND "palliative care" and their multiple combinations.
RESULTS
Eleven studies were selected, in which terms such as spiritual well-being, absence of discomfort and quality of life were used in substitution of psychological well-being and a certain consensus was found regarding whether resilience, spirituality and social support are predictive variables of psychological well-being.
CONCLUSIONS
Resilience, social support and spirituality are highly relevant variables at the end of life and contribute decisively towards psychological well-being.
Topics: Humans; Psychological Well-Being; Quality of Life; Palliative Care; Spirituality; Death; Resilience, Psychological
PubMed: 34039108
DOI: 10.1177/00302228211019203 -
Journal of Palliative Medicine Oct 2017The availability of smartphone applications has increased rapidly including applications related to palliative care. The scope of these available apps has not been... (Review)
Review
BACKGROUND
The availability of smartphone applications has increased rapidly including applications related to palliative care. The scope of these available apps has not been synthesized.
OBJECTIVE
The purpose of this study was to identify and review available palliative care-related smartphone applications for clinicians.
DESIGN
Smartphone application platform stores, for example, App Store iOS, Google Play Store, Windows App-Microsoft Store, and Blackberry World App store were searched (December 2016) using relevant key words.
RESULTS
Forty-six palliative care applications targeting clinicians were identified, including clinical guidelines (n = 17), advance care planning (n = 9), training materials in palliative care (n = 7), and pharmaceutical tools (n = 7), and platforms for distributing current palliative care news, articles, and opinions (n = 6). The majority of the applications were free and available in English. The most common platforms were Android and iOS.
CONCLUSIONS
The number of palliative care apps targeting clinicians has increased dramatically for the past five years. However, many apps did not report adequate information to judge the evidence upon which the apps were based.
Topics: Humans; Information Technology; Mobile Applications; Palliative Care
PubMed: 28557549
DOI: 10.1089/jpm.2017.0070 -
Patient Education and Counseling Aug 2022The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people. (Review)
Review
OBJECTIVES
The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people.
METHODS
The review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool.
RESULTS
Twenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people.
CONCLUSION
Palliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication.
PRACTICE IMPLICATIONS
Facilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging.
Topics: Aged; Communication; Curriculum; Health Personnel; Hospice and Palliative Care Nursing; Humans; Palliative Care
PubMed: 35459530
DOI: 10.1016/j.pec.2022.04.003 -
The American Journal of Hospice &... Jan 2018Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it... (Review)
Review
BACKGROUND
Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions.
OBJECTIVES
To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes.
DESIGN
Systematic review.
STUDY SELECTION
English-language articles analyzing multicomponent palliative care interventions.
OUTCOMES MEASURED
Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life).
RESULTS
Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes.
CONCLUSIONS
While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.
Topics: Chronic Disease; Clergy; Health Personnel; Hospice Care; Humans; Palliative Care; Patient Care Planning; Patient Care Team; Patient Education as Topic; Quality of Life; Religion; Social Workers; Terminally Ill
PubMed: 28273750
DOI: 10.1177/1049909116674669 -
Annals of Palliative Medicine Sep 2023The compassionate communities (CC) movement is an emergent health promotion approach to palliative care that views illness, dying, death, and loss as universal...
BACKGROUND
The compassionate communities (CC) movement is an emergent health promotion approach to palliative care that views illness, dying, death, and loss as universal experiences, and challenges the notion that disease precludes one from health care attention and interest. It seeks to normalise these phenomena and reorientate care to communities by activating naturally occurring networks and mobilising community resources. A surge of interventions aligned with the ethos of CC has been observed over the last decade. This scoping review seeks to synthesise what is currently known about the design, efficacy, and impact of CC interventions.
METHODS
Cochrane, PubMed, Scopus, and Web of Science were systematically searched. Hand searching was performed on three key journals, reference lists and citation lists of included articles, and relevant review articles. Two levels of analysis were conducted. First, a numerical presentation of the characteristics of CC interventions. Second, a thematically orientated narrative analysis of intervention efficacy.
RESULTS
A total of 1,882 records were screened; 62 papers were included. Most were implemented by palliative care organisations in Europe, North America, and Australia. Included studies were mapped against Clark et al.'s taxonomy of end-of-life interventions: educational (n=17); service (n=20); clinical (n=3); cultural (n=4); and multi-dimensional (n=18) interventions are discussed. While preliminary findings are positive, claims of efficacy are limited due to methodological paucity in the field.
CONCLUSIONS
We argue that the field would benefit from more transparent and theoretically driven CC interventions in order to explicate the mechanism(s) for successful intervention implementation.
Topics: Humans; Palliative Care; Australia; Europe
PubMed: 37475658
DOI: 10.21037/apm-22-867 -
Annals of Palliative Medicine Oct 2022People receiving palliative care have complex, wide-ranging, and changing needs, not just physical distress, but also psychosocial, practical, and spiritual. Influences...
BACKGROUND
People receiving palliative care have complex, wide-ranging, and changing needs, not just physical distress, but also psychosocial, practical, and spiritual. Influences on complexity in palliative care are different among healthcare providers and may depend on diverse aspects of the patient's condition, time, and environment. Therefore, this study aimed to integrate and describe the perspective of complexity in palliative care.
METHODS
We used an integrative review, which is a method of compiling, summarizing, and analyzing existing insights from previous studies. We conducted an electronic literature search in MEDLINE (Ovid), PsycINFO (EBSCOhost), Web of Science Core Collection, and CINAHL (EBSCOhost), examining literature from May 1972 to September 2020 and updated in December 2020. Subsequently, synthesis without meta-analysis of the findings was completed.
RESULTS
We identified 32 peer-reviewed articles published in English. The included literature mainly originated in Europe and the United States. The research methods included quantitative studies (n=13), qualitative studies (n=12), case studies (n=3), and reviews (n=4). We identified 29 that influenced complexity in palliative care, 25 perceptions of the patient, including background and physical, psychological, social, and spiritual; two perceptions in the healthcare setting; and two perceptions in the socio-cultural setting. Above all, the perceptions of complexity in palliative care included younger age, prognosis, and spirituality. In addition, we added the identified perceptions of complexity with references to the complexity model in palliative care.
CONCLUSIONS
Although this review was limited in its search strategy and some data sources may have been overlooked, it still provided perceptions that influenced complexity in palliative care. These complex influencing perceptions are necessary for patients to receive appropriate palliative care at the right time and for health care providers to conduct a multi-disciplinary team approach. Furthermore, longitudinal prospective data are needed to examine the changes and relationships among complexity over time.
Topics: Humans; Palliative Care; Prospective Studies; Hospice and Palliative Care Nursing; Qualitative Research; Spirituality
PubMed: 36226646
DOI: 10.21037/apm-22-623