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Journal of Surgical Oncology Jul 2019Palliative care, unlike hospice, can be utilized concurrently with disease-modifying or curative therapies. Some of the benefits of palliative care include improved... (Review)
Review
Palliative care, unlike hospice, can be utilized concurrently with disease-modifying or curative therapies. Some of the benefits of palliative care include improved quality of life, less end-of-life treatment, and decreased medical costs. Furthermore, palliative care can help guide treatment decisions to be in line with patients' physical, psychological, and spiritual needs. On the basis of these benefits, we advocate for palliative care involvement early in the course of advanced malignancy and other terminal diagnoses.
Topics: Health Services Accessibility; Hospice Care; Humans; Neoplasms; Palliative Care; Quality of Life; Referral and Consultation; Time Factors; Treatment Outcome
PubMed: 31102469
DOI: 10.1002/jso.25499 -
Journal of Medical Radiation Sciences Dec 2016Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of... (Meta-Analysis)
Meta-Analysis Review
Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.
Topics: Humans; Neoplasms; Palliative Care; Physician-Patient Relations; Truth Disclosure
PubMed: 27741380
DOI: 10.1002/jmrs.188 -
The Medical Clinics of North America May 2020
Topics: Humans; Palliative Care; Primary Health Care; Quality of Life
PubMed: 32312417
DOI: 10.1016/j.mcna.2020.02.001 -
Journal of Hospice and Palliative... Apr 2018Providing palliative care involves serious challenges for nurses, such as end-of-life decisions, contact with people's suffering and dying, and increased risk of...
Providing palliative care involves serious challenges for nurses, such as end-of-life decisions, contact with people's suffering and dying, and increased risk of burnout. However, studies have revealed that the burnout level of health professionals working in palliative care is lower than that of health professionals working in other settings. This study aimed to describe the lived experiences of nurses caring in a palliative care unit. A phenomenological descriptive study was undertaken. Nine nurses were recruited from a palliative care unit in Portugal. Data were collected using individual interviews and analyzed following the method of Giorgi. Five themes reflect the essence of the lived experience: (1) experience centered on the relationship with the other (ie, the patient and the family), (2) experience centered on the relationship with one's own self, (3) exhausting experience, (4) rewarding experience, and (5) the team as a pillar. These findings can be valuable for understanding the challenges and strategies experienced by nurses caring in palliative care and for designing interventions that focus on reducing the risk of burnout among nurses-not only those working in palliative care but also those working in other contexts who experience regular contact with suffering and death.
Topics: Adult; Burnout, Professional; Empathy; Female; Humans; Life Change Events; Male; Middle Aged; Nurses; Palliative Care; Portugal; Qualitative Research
PubMed: 30063572
DOI: 10.1097/NJH.0000000000000428 -
BMC Palliative Care Aug 2019Recognising and knowing how to manage ethical issues and moral dilemmas can be considered an ethical skill. In this study, ethics of care is used as a theoretical...
BACKGROUND
Recognising and knowing how to manage ethical issues and moral dilemmas can be considered an ethical skill. In this study, ethics of care is used as a theoretical framework and as a regulatory criterion in the relationship among healthcare professionals, patients with palliative care needs and family members. This study is a part of a larger project aimed at developing and implementing a training programme on "ethical communication" addressed to professionals caring for patients with palliative care needs. The aim of this study was comprehending whether and how the ethics of care informs the way healthcare professionals make sense of and handle ethical issues in palliative care.
METHODS
Qualitative study employing a theoretically driven thematic analysis performed on semi-structured interviews. The research was conducted in a clinical cancer centre in northern Italy. Eligible participants were physicians and nurses from eleven hospital wards who assisted patients with chronic advanced disease daily and had previously attended a 4-h training on palliative care held by the hospital Palliative Care Unit.
RESULTS
The researchers identified five themes: morality is providing global care; morality is knowing how to have a relationship with patients; morality is recognizing moral principles; moral dimension and communication; and moral dilemmas are individual conflicts.
CONCLUSIONS
Ethics of care seems to emerge as a theoretical framework that includes the belief systems of healthcare professionals, especially those assisting patients with palliative care needs; moreover, it allows the values of both the patients and professionals to come to light through the relationship of care. Ethics of care is also appropriate as a framework for ethical training.
Topics: Adult; Aged; Ethics, Medical; Family; Female; Humans; Interviews as Topic; Italy; Male; Middle Aged; Moral Obligations; Palliative Care; Physicians; Qualitative Research
PubMed: 31399094
DOI: 10.1186/s12904-019-0453-2 -
BMC Palliative Care Apr 2020Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with... (Meta-Analysis)
Meta-Analysis
Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families.
BACKGROUND
Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families.
METHODS
A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis.
RESULTS
Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients' openness to their own needs).
CONCLUSIONS
To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals' communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.
Topics: Family; Health Personnel; Humans; Neoplasms; Palliative Care; Patient Acceptance of Health Care; Patients; Qualitative Research
PubMed: 32284064
DOI: 10.1186/s12904-020-00556-7 -
Brazilian Journal of Anesthesiology... 2019Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients... (Review)
Review
BACKGROUND AND OBJECTIVE
Palliative sedation is a medical procedure that has been used for more than 25 years to relieve refractory symptoms not responsive to any previous treatment in patients with no possibility of cure and near the end of life. Many uncertainties persist on the theme regarding definition, indications, decision making, most appropriate place to perform the procedure, most used drugs, need for monitoring, fluids and nutritional support, and possible ethical dilemmas. The objective of this review was to seek a probable consensus among the authors regarding these topics not yet fully defined.
METHOD
An exploratory search was made in secondary sources, from 1990 to 2016, regarding palliative sedation and its clinical and bioethical implications.
CONCLUSIONS
Palliative sedation is an alternative to alleviate end-of-life patient suffering due to refractory symptoms, particularly dyspnea and delirium, after all other treatment options have been exhausted. Decision making involves prior explanations, discussions and agreement of the team, patient, and/or family members. It can be performed in general hospital units, hospices and even at home. Midazolam is the most indicated drug, and neuroleptics may also be required in the presence of delirium. These patients’ monitoring is limited to comfort observation, relief of symptoms, and presence of adverse effects. There is no consensus on whether or not to suspend fluid and nutritional support, and the decision must be made with family members. From the bioethical standpoint, the great majority of authors are based on intention and proportionality to distinguish between palliative sedation, euthanasia, or assisted suicide.
Topics: Clinical Decision-Making; Deep Sedation; Humans; Palliative Care; Terminal Care
PubMed: 29776669
DOI: 10.1016/j.bjan.2018.03.002 -
Nutrients May 2021Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The...
Nutritional management of patients under palliative care can lead to ethical issues, especially when Enteral Nutrition (EN) is prescribed by nasogastric tube (NGT). The aim of this review is to know the current status in the management of EN by NG tube in patients under palliative care, and its effect in their wellbeing and quality of life. The following databases were used: PubMed, Web of Science (WOS), Scopus, Scielo, Embase and Medline. After inclusion and exclusion criteria were applied, as well as different qualities screening, a total of three entries were used, published between 2015 and 2020. In total, 403 articles were identified initially, from which three were selected for this review. The use of NGT caused fewer diarrhea episodes and more restrictions than the group that did not use NG tubes. Furthermore, the use of tubes increased attendances to the emergency department, although there was no contrast between NGT and PEG devices. No statistical difference was found between use of tubes (NGT and PEG) or no use, with respect to the treatment of symptoms, level of comfort, and satisfaction at the end of life. Nevertheless, it improved hospital survival compared with other procedures, and differences were found in hospital stays in relation to the use of other probes or devices. Finally, there are not enough quality studies to provide evidence on improving the health status and quality of life of the use of EN through NGT in patients receiving palliative care. For this reason, decision making in this field must be carried out individually, weighing the benefits and damages that they can cause in the quality of life of the patients.
Topics: Adult; Enteral Nutrition; Female; Humans; Intubation, Gastrointestinal; Length of Stay; Male; Palliative Care; Quality of Life; Treatment Outcome
PubMed: 34066386
DOI: 10.3390/nu13051562 -
Clinics in Geriatric Medicine Feb 2019Although many seniors cite maintaining independence and a desire to die at home as health priorities, admission to the ICU and the use of invasive procedures are common... (Review)
Review
Although many seniors cite maintaining independence and a desire to die at home as health priorities, admission to the ICU and the use of invasive procedures are common near the end of life. Palliative care aims to relieve pain and other symptoms to maintain the highest quality of life for the longest period of time, but surgical patients are less likely to be referred to palliative care than patients with chronic medical conditions. Meeting the palliative care needs of elderly surgical patients requires early recognition, advance care planning, and multidisciplinary interventions that align patient goals with possible outcomes.
Topics: Advance Care Planning; Aged; Geriatrics; Humans; Palliative Care; Quality of Life; Risk Adjustment; Surgical Procedures, Operative
PubMed: 30390982
DOI: 10.1016/j.cger.2018.08.004 -
Seminars in Perinatology Mar 2017
Topics: Clinical Competence; Humans; Intensive Care, Neonatal; Palliative Care; Perinatal Care; Perinatology; Professional-Family Relations
PubMed: 28109538
DOI: 10.1053/j.semperi.2016.11.004