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The Medical Clinics of North America Nov 2017The palliative care approach for survivors begins with comprehensive assessment of communication and advance care planning needs and the physical, psychological and... (Review)
Review
The palliative care approach for survivors begins with comprehensive assessment of communication and advance care planning needs and the physical, psychological and psychiatric, social, spiritual and religious, and cultural domains. Communication and decision-making about difficult issues should include responding to emotions, planning for future communication needs, and considering reasons for miscommunication. Key palliative approaches to symptom management include addressing physical and psychosocial concerns, and using nonpharmacologic approaches first or together with medications. Physicians should address advance care planning in older cancer survivors and those at significant risk of recurrence and mortality, ideally through ongoing conversations in a longitudinal care relationship.
Topics: Advance Care Planning; Communication; Emotions; Family Relations; Humans; Neoplasms; Palliative Care; Patient Care Team; Patient-Centered Care; Survivors; Time Factors
PubMed: 28992862
DOI: 10.1016/j.mcna.2017.06.009 -
Journal of Palliative Medicine Jan 2018Integrated palliative care is viewed as having the potential to improve service coordination, efficiency, and quality outcomes for patients and family carers. However,...
Integrated palliative care is viewed as having the potential to improve service coordination, efficiency, and quality outcomes for patients and family carers. However, the majority of Canadians do not have access to regional, comprehensive, integrated palliative care. Work needs to be directed toward planning palliative care services that is integrated into the healthcare and social care system. To further this goal, it is important to have a conceptual understanding of the meaning of integrated care and its expression in organizational models for the provision of palliative care.
Topics: Canada; Delivery of Health Care, Integrated; Health Services Accessibility; Humans; Palliative Care
PubMed: 29283874
DOI: 10.1089/jpm.2017.0430 -
Journal of Pain and Symptom Management Mar 2022Palliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear. (Review)
Review
CONTEXT
Palliative care (PC) research has grown over the last 20 years. Yet, the causal components and pathways of PC interventions remain unclear.
OBJECTIVES
To document the prevalence and application of theoretical frameworks in developing and testing PC interventions.
METHODS
We conducted a secondary analysis of previously published systematic reviews of PC randomized clinical trials. Trials were evaluated for explicit mention of a theoretical framework, process or delivery model, or clinical practice guideline that supported the development of the intervention. We used a structured data extraction form to document study population, outcomes, and whether and how authors used a theoretical framework, process/delivery model, or clinical practice guideline. We applied an adapted coding scheme to evaluate use of theoretical frameworks.
RESULTS
We reviewed 85 PC trials conducted between 1984 and 2021. Thirty-eight percent (n = 32) of trials explicitly mentioned a theoretical framework, process or delivery model, or clinical practice guideline as a foundation for the intervention design. Only nine trials included a theoretical framework, while the remaining 23 cited a process/delivery model or clinical practice guideline.
CONCLUSION
Most PC trials do not cite a theoretical foundation for their intervention design. Future work should focus on developing and validating new theoretical frameworks and modifying existing theories and models to better explain the mechanisms of the variety of PC interventions.
Topics: Hospice and Palliative Care Nursing; Humans; Models, Theoretical; Palliative Care; Practice Guidelines as Topic; Process Assessment, Health Care; Randomized Controlled Trials as Topic; Systematic Reviews as Topic
PubMed: 34756957
DOI: 10.1016/j.jpainsymman.2021.10.011 -
Australian Journal of General Practice Nov 2018
Topics: Humans; Palliative Care; Quality of Health Care
PubMed: 31207669
DOI: 10.31128/AJGP-11-18-1234e -
Current Opinion in Supportive and... Mar 2016Transcatheter aortic valve implantation (TAVI) is the recommended treatment for most patients with symptomatic aortic stenosis at high surgical risk. However, TAVI may... (Review)
Review
PURPOSE OF REVIEW
Transcatheter aortic valve implantation (TAVI) is the recommended treatment for most patients with symptomatic aortic stenosis at high surgical risk. However, TAVI may be clinically futile for patients who have multiple comorbidities and excessive frailty. This group benefits from transition to palliative care to maximize quality of life, improve symptoms, and ensure continuity of health services. We discuss the clinical determination of utility and futility, explore the current evidence guiding the integration of palliative care in procedure-focused cardiac programs, and outline recommendations for TAVI programs.
RECENT FINDINGS
The determination of futility of treatment in elderly patients with aortic stenosis is challenging. There is a paucity of research available to guide best practices when TAVI is not an option. Opportunities exist to build on the evidence gained in the management of end of life and heart failure. TAVI programs and primary care providers can facilitate improved communication and processes of care to provide decision support and transition to palliative care.
SUMMARY
The increased availability of transcatheter options for the management of valvular heart disease will increase the assessment of people with life-limiting conditions for whom treatment may not be an option. It is pivotal to bridge cardiac innovation and palliation to optimize patient outcomes.
Topics: Aortic Valve Stenosis; Communication; Humans; Medical Futility; Palliative Care; Quality of Life; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement
PubMed: 26716394
DOI: 10.1097/SPC.0000000000000180 -
BMC Palliative Care May 2024The integral model of Palliative Care recognizes the community as essential element in improving quality of life of patients and families. It is necessary to find a... (Review)
Review
BACKGROUND
The integral model of Palliative Care recognizes the community as essential element in improving quality of life of patients and families. It is necessary to find a formula that allows the community to have a voice. The aim of this scoping review is to identify barriers and facilitators to engage community in PC.
METHODS
Systematic search was conducted in NICE, Cochrane Library, Health Evidence, CINAHL and PubMed database.
KEYWORDS
Palliative care, End of life care, community networks, community engagement, public engagement, community participation, social participation, barriers and facilitators.
RESULTS
Nine hundred seventy-one results were obtained. Search strategy and inclusion criteria yielded 13 studies that were read in detail to identify factors influencing community engagement in palliative care, categorized into: Public health and public engagement; Community attitudes towards palliative care, death and preferences at the end of life; Importance of volunteers in public engagement programs; Compassionate communities.
CONCLUSION
Societal awareness must be a facilitated process to catalyse public engagement efforts. National policy initiatives and regional system support provide legitimacy and focus is essential for funding. The first step is to get a sense of what is important to society, bearing in mind cultural differences and to channel those aspects through health care professionals; connecting the most assistential part with community resources. The process and long-term results need to be systematically evaluated.
Topics: Humans; Community Participation; Palliative Care; Terminal Care; Community Networks
PubMed: 38711035
DOI: 10.1186/s12904-024-01424-4 -
Journal of Pain and Symptom Management Feb 2018Palliative care patients face legal issues that impact their quality of life. Legal support, embedded in holistic palliative care services, has developed globally over...
CONTEXT
Palliative care patients face legal issues that impact their quality of life. Legal support, embedded in holistic palliative care services, has developed globally over the last decade to address this.
OBJECTIVES
This article aims to trace the origins of legal support for palliative care patients, detail models of legal support, and describe achievements and challenges.
METHODS
The article draws on years of work in this area and the available literature.
RESULTS
Common legal issues include disposing of property and drafting wills, planning for children, dealing with debt and securing social benefits, and addressing discrimination. Diverse approaches to integrating legal support include developing paralegal skills, accessing skilled legal advice, empowering patients and families, and building awareness of rights among health care workers.
CONCLUSION
There is robust and growing acceptance of legal support as a key component of holistic palliative care, and many palliative care professionals are identifying and addressing the legal needs they encounter through mediation, guidance on basic rights, or referrals to a lawyer. Addressing legal problems can contribute to peace of mind, well-being, and the health of patients.
Topics: Health Personnel; Humans; Internationality; Palliative Care; Patient Advocacy; Patient Participation; Patient Rights; Social Support; Terminal Care
PubMed: 28801002
DOI: 10.1016/j.jpainsymman.2017.03.025 -
Chinese Clinical Oncology Jun 2018Palliative care acknowledges the historical origin of the hospice developed in the UK during the 20th century. Palliative care initially focused primarily on end-of-life... (Review)
Review
Palliative care acknowledges the historical origin of the hospice developed in the UK during the 20th century. Palliative care initially focused primarily on end-of-life care provided at hospices, but then changed to at-home care, leading to the formation of a support system provided by the palliative care team. The palliative care team further coordinated with acute care hospitals and became involved in earlier stages of care as well, such as providing symptomatic relief in conjunction with cancer treatment. On this backdrop, the concept of palliative care itself also evolved over time. In recent years, attempts at early-stage palliative care from the initial stages of treatment are being studied with respect to cases with complications such as advanced cancer. Early-stage palliative care has been reported to improve patient quality of life (QOL), improve depression, reduce the burden on the family, and possibly improve survival prognosis for some advanced cancers. Currently, efforts to integrate palliative care into standard oncology care regimens by providing specialist palliative care and cancer treatment as a single unit are anticipated to enter more widespread practice. Such a care approach differs from conventional palliative care, which is started around the time when the end of conventional cancer treatment, and consists of applying specialist palliative care from the stage where cancer treatments are administered to address with multiple problems. Many breast cancer patients have severe problems such as esthetic outcome, sexuality and psycho-social effects associated with breast cancer itself and treatment. And it effects their QOL for a long time not only during therapy but also having done therapy or recurrence. Therefore, it may be effectiveness for patients to integrate of palliative care into standard oncology care in breast cancer, but the effect of it for only breast cancer patients has not been reported on yet. In this paper, after reviewing the concepts and historical evolution of palliative care, we describe the integration of palliative care into standard oncology care that has been making progress recently.
Topics: History, 20th Century; History, 21st Century; Humans; Integrative Oncology; Medical Oncology; Palliative Care; Standard of Care
PubMed: 30056734
DOI: 10.21037/cco.2018.06.02 -
BMC Palliative Care Oct 2020With a growing world population, a longer life expectancy, and more deaths due to chronic diseases, the need for palliative care is increasing. Palliative care aims to... (Review)
Review
BACKGROUND
With a growing world population, a longer life expectancy, and more deaths due to chronic diseases, the need for palliative care is increasing. Palliative care aims to alleviate suffering and to promote well-being for patients with progressive, incurable disease or injury. E-Health entails using of information and communication technology for healthcare provision. It is unclear to how patients experience use of eHealth technology within palliative care.
METHODS
The aim of this study was to describe patients' experiences of eHealth in palliative care. A systematic integrative review was performed using six databases: Cinahl Complete; MEDLINE; PubMed; Psychology and Behavioral Sciences Collection; Nursing and Allied Health; and PsycINFO. Twelve studies met the inclusion criteria of adult patients in palliative care, English language, published 2014-2019: comprising 397 patients. Six studies were from European countries, four from North America, one from South America and one from Oceania. Seven were feasibility or pilot studies.
RESULTS
The findings are synthesized in the main theme: E-health applications - promoting communication on patients' and families' terms, and three sub- themes: usability and feasibility of eHealth applications; symptom control and individualized care; and use of eHealth applications increased sense of security and patient safety. Patients' experiences were that eHealth promoted individualized care, sense of security, better symptom management and participation in care. Communication was facilitated by the inherent flexibility provided by technology.
CONCLUSIONS
E-Health applications seem promising in promoting equal, individualized care, and may be a tool to endorse accessibility and patient participation in palliative care settings. Indications are that eHealth communication resulted in patients and families receiving more information, which contributed to experiences of patient safety and feelings of security. At organizational and societal levels, eHealth may contribute to sustainable development and more efficient use of resources.
Topics: Humans; Palliative Care; Patient Satisfaction; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 33054746
DOI: 10.1186/s12904-020-00667-1 -
BMC Palliative Care Mar 2018The aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to... (Review)
Review
BACKGROUND
The aim of palliative care is to improve the quality of life of patients and families through the prevention and relief of suffering. Frequently, patients may choose to receive palliative care in the home. The objective of this paper is to summarize the quality and primary outcomes measured within the palliative care in the home literature. This will synthesize the current state of the literature and inform future work.
METHODS
A scoping review was completed using PRISMA guidelines. PubMed, Embase, CINAHL, Web of Science, Cochrane Library, EconLit, PsycINFO, Centre for Reviews and Dissemination, Database of Abstracts of Reviews of Effects, and National Health Service Economic Evaluation Database were searched from inception to August 2016. Inclusion criteria included: 1) care was provided in the "home of the patient" as defined by the study, 2) outcomes were reported, and 3) reported original data. Thematic component analysis was completed to categorize interventions.
RESULTS
Fifty-three studies formed the final data set. The literature varied extensively. Five themes were identified: accessibility of healthcare, caregiver support, individualized patient centered care, multidisciplinary care provision, and quality improvement. Primary outcomes were resource use, symptom burden, quality of life, satisfaction, caregiver distress, place of death, cost analysis, or described experiences. The majority of studies were of moderate or unclear quality.
CONCLUSIONS
There is robust literature of varying quality, assessing different components of palliative care in the home interventions, and measuring different outcomes. To be meaningful to patients, these interventions need to be consistently evaluated with outcomes that matter to patients. Future research could focus on reaching a consensus for outcomes to evaluate palliative care in the home interventions.
Topics: Home Care Services; Humans; Outcome Assessment, Health Care; Palliative Care; Quality of Life
PubMed: 29514620
DOI: 10.1186/s12904-018-0299-z