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Revista Brasileira de Enfermagem Jun 2016to analyze scientifi c articles published in international online journals about palliative care and spirituality. (Review)
Review
OBJECTIVE
to analyze scientifi c articles published in international online journals about palliative care and spirituality.
METHODS
an integrative literature review with data collected in September 2014 from the LILACS, SCIELO, MEDLINE/PubMed, and IBECS databases.
RESULTS
thirty-nine publications were identifi ed and their textual analysis facilitated through four thematic approaches: the meaning of spirituality in the context of palliative care; palliative care and spiritual support; spirituality and relief of pain and other symptoms in patients under palliative care; and instruments to evaluate the spiritual dimension of the scope of palliative care.
CONCLUSION
this study examined the relevance of the spiritual dimension in the care of patients with palliative care and the need for developing new studies to disseminate knowledge about this topic.
DESCRIPTORS
Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health.
Topics: Humans; Palliative Care; Spiritual Therapies; Spirituality
PubMed: 27355311
DOI: 10.1590/0034-7167.2016690324i -
Nutrients Jan 2021The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a... (Review)
Review
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
Topics: Counseling; Humans; Malnutrition; Neoplasms; Nutrition Assessment; Nutritional Support; Palliative Care; Quality of Life
PubMed: 33498997
DOI: 10.3390/nu13020306 -
Journal of the American College of... Oct 2017Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an... (Review)
Review
Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.
Topics: Disease Progression; Family Health; Heart Failure; Humans; Palliative Care; Patient Care Team; Patient Comfort; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 28982506
DOI: 10.1016/j.jacc.2017.08.036 -
BMC Geriatrics Sep 2018In aging societies, the last phase of people's lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both... (Review)
Review
In aging societies, the last phase of people's lives changes profoundly, challenging traditional care provision in geriatric medicine and palliative care. Both specialties have to collaborate closely and geriatric palliative care (GPC) should be conceptualized as an interdisciplinary field of care and research based on the synergies of the two and an ethics of care.Major challenges characterizing the emerging field of GPC concern (1) the development of methodologically creative and ethically sound research to promote evidence-based care and teaching; (2) the promotion of responsible care and treatment decision making in the face of multiple complicating factors related to decisional capacity, communication and behavioural problems, extended disease trajectories and complex social contexts; (3) the implementation of coordinated, continuous care despite the increasing fragmentation, sectorization and specialization in health care.Exemplary strategies to address these challenges are presented: (1) GPC research could be enhanced by specific funding programs, specific patient registries and anticipatory consent procedures; (2) treatment decision making can be significantly improved using advance care planning programs that include adequate decision aids, including those that address proxies of patient who have lost decisional capacity; (3) care coordination and continuity require multiple approaches, such as care transition programs, electronic solutions, and professionals who act as key integrators.
Topics: Advance Care Planning; Aged; Clinical Decision-Making; Delivery of Health Care; Geriatrics; Humans; Palliative Care
PubMed: 30236063
DOI: 10.1186/s12877-018-0914-0 -
Australian Journal of General Practice Nov 2018While most people say they would prefer to be cared for and to die at home, this outcome is often not achieved. This represents a service gap that general practitioners...
BACKGROUND
While most people say they would prefer to be cared for and to die at home, this outcome is often not achieved. This represents a service gap that general practitioners (GPs) are optimally positioned to fill.
OBJECTIVES
The aim of this paper is to synthesise existing evidence-based frameworks of palliative care together with other resources, to present a cohesive model of care that GPs can easily systematise to guide high-quality home-based palliative care.
DISCUSSION
Key clinical processes include advance care planning and development of medical goals of patient care plans and terminal care plans. Three essential elements for high-quality palliative care incorporated into the model include a compassionate GP, the care team and various practical resources. Palliative care sits well within the GP specialist scope of practice. GPs have at their disposal many resources that effectively and efficiently support them in their palliative care practice.
Topics: Advance Care Planning; Attitude of Health Personnel; General Practice; Home Care Services; Humans; Palliative Care
PubMed: 31207670
DOI: 10.31128/AJGP-06-18-4607 -
Journal of Health Psychology Mar 2019In palliative care, a biopsychosocial-spiritual model is essential to address the patient in totality. Spirituality is often a relevant issue in such settings, yet there...
In palliative care, a biopsychosocial-spiritual model is essential to address the patient in totality. Spirituality is often a relevant issue in such settings, yet there is a need to differentiate spirituality from religion. Spirituality in palliative care focuses on the psychological and spiritual aspects of care, helping to relieve the physical, emotional, social and spiritual distresses of the patient, family members and healthcare professionals, produced in such conditions. Psychologists, according to their ethical responsibilities, may include the assessment of their patients' spiritual needs in therapy, as it will help to identify the patients' values, belief systems, spiritual history, distress and needs. All patients have different needs, some may need religious/spiritual guidance, in collaboration with spiritual care workers, and others may not demonstrate needs regarding these issues. The essential is that each patient is treated as a 'whole', addressing his physical, psychological, social and spiritual needs.
Topics: Humans; Palliative Care; Spirituality
PubMed: 27531369
DOI: 10.1177/1359105316664138 -
CA: a Cancer Journal For Clinicians Sep 2018Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer.... (Review)
Review
Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-the-science review directed at the practicing cancer clinician, the authors first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. Then, conceptual models are provided to support team-based, timely, and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multidimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventive care to minimize crises at the end of life. Targeted palliative care involves identifying the patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral, are summarized. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time. CA Cancer J Clin. 2018;680:00-00. 2018 American Cancer Society, Inc.
Topics: Ambulatory Care; Caregivers; Delivery of Health Care; Evidence-Based Medicine; Humans; Neoplasms; Oncologists; Palliative Care; Patient Care Team; Physician's Role; Quality of Life; Referral and Consultation; Time-to-Treatment
PubMed: 30277572
DOI: 10.3322/caac.21490 -
Canadian Family Physician Medecin de... Apr 2019To help increase the confidence of both caregivers and clinicians in providing palliative care to adults with intellectual and developmental disabilities (IDD) using an... (Review)
Review
OBJECTIVE
To help increase the confidence of both caregivers and clinicians in providing palliative care to adults with intellectual and developmental disabilities (IDD) using an easy-to-follow framework to improve and overcome barriers to effective palliative care in this population.
QUALITY OF EVIDENCE
A literature review was conducted to explore recent best evidence to address these palliative care needs and to allow for a focused opportunity to consider the details of implementing clinical practice guidelines in the palliative care context. Evidence ranges from level I to level III.
MAIN MESSAGE
Pain and psychological and emotional distress are important issues for individuals with IDD, as they can be difficult to assess and measure, and often present atypically, especially in those with limited communication skills. Further, little is known about end-of-life needs in the adult population with IDD, especially for those living in community residences. The conducted literature review of patient, caregiver, and clinician experiences exposed considerable barriers, including incorrect assumptions about patients' capacity to understand and discomfort of both caregivers and clinicians with open communication. This has resulted in exclusion of adults with IDD from their own care, which has proven harmful. Maximizing time in familiar surroundings and establishing trust and continuity are crucial. Sometimes trial and error with empiric use of comfort medications is necessary, but this can be mitigated with careful examination of distress patterns and judicious use of diagnostic testing. It is always best to integrate the palliative approach into the existing pattern of care.
CONCLUSION
The validated tools and recommendations provided will assist with communication, symptom interpretation, treatment decisions, advanced care planning, addressing grief, and important considerations in end-of-life care.
Topics: Adult; Aged; Caregivers; Communication; Decision Making; Female; Health Services for Persons with Disabilities; Humans; Male; Middle Aged; Palliative Care; Persons with Mental Disabilities; Physician-Patient Relations
PubMed: 31023774
DOI: No ID Found -
The Lancet. Respiratory Medicine Dec 2017Progressive fibrotic interstitial lung diseases (ILDs) are characterised by major reductions in quality of life and survival and have similarities to certain... (Review)
Review
Progressive fibrotic interstitial lung diseases (ILDs) are characterised by major reductions in quality of life and survival and have similarities to certain malignancies. However, palliative care expertise is conspicuously inaccessible to many patients with ILD. Unmet patient and caregiver needs include effective pharmacological and psychosocial interventions to improve quality of life throughout the disease course, sensitive advanced care planning, and timely patient-centred end-of-life care. The incorrect perception that palliative care is synonymous with end-of-life care, with no role earlier in the course of ILD, has created a culture of neglect. Interventions that aim to improve life expectancy are often prioritised without rigorous assessment of the individual's health and psychosocial needs, thereby inadvertently reducing quality of life. As in malignant disorders, radical interventions to slow disease progression and palliative measures to improve quality of life should both be prioritised. Efficient patient-centred models of palliative care must be validated, taking into account religious and cultural differences, as well as variability of resources. Effective implementation of palliative care for ILD will require multidisciplinary participation from clinicians, specialist nurses, psychologists, social workers, and, in some countries, non-governmental faith and community-based organisations with access to palliative care expertise.
Topics: Caregivers; Chronic Disease; Disease Progression; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Humans; Lung Diseases, Interstitial; Palliative Care; Quality of Life
PubMed: 29033267
DOI: 10.1016/S2213-2600(17)30383-1 -
Journal of Pain and Symptom Management May 2018Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are...
Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally.
Topics: Culturally Competent Care; Culture; Decision Making; Health Communication; Humans; Palliative Care; Patient Preference
PubMed: 29366913
DOI: 10.1016/j.jpainsymman.2018.01.007