-
Current Oncology (Toronto, Ont.) Nov 2023Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare...
Cancer pain intensity (PI) fluctuates, but the relationship between pain flares and background pain with respect to pain management is not settled. We studied how flare and background PIs corresponded with treatment results for background cancer pain. Patients admitted to an acute palliative care unit with average and/or worst PI ≥ 1 on the 11-point numeric rating scale were included. Average and worst PI at admission and average PI at discharge were collected. We examined how the difference and ratio between worst and average PI and average PI at admission, were associated with average PI development during hospitalization. Positive differences between worst and average PI at admission were defined as pain flares. Ninety out of 131 patients had pain flares. The reduction in average PI for patients with flares was 0.9 and for those without, 1.9 ( = 0.02). Patients with large worst minus average PI differences reported the least improvement, as did those with large worst/average PI ratios. Patients with pain flares and average PI ≤ 4 at admission had unchanged average PI during hospitalization, while those with pain flares and average PI > 4 experienced pain reduction (2.1, < 0.001). Large pain flares, in absolute values and compared to background PI, were associated with inferior pain relief.
Topics: Humans; Palliative Care; Cancer Pain; Pain; Neoplasms; Pain Management
PubMed: 38132380
DOI: 10.3390/curroncol30120746 -
Open Heart Dec 2023(1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the...
OBJECTIVES
(1) Develop a programme theory of why, for whom and in what contexts integrated palliative care (PC) and heart failure (HF) services work/do not work; (2) use the programme theory to co-produce with stakeholders, intervention strategies to inform best practice and future research.
METHODS
A systematic review of all published articles and grey literature using a realist logic of analysis. The search strategy combined terms significant to the review questions: HF, PC and end of life. Documents were included if they were in English and provided data relevant to integration of PC and HF services. Searches were conducted in November 2021 in EMBASE, MEDLINE, PsycINFO, AMED, HMIC and CINAHL. Further relevant documents were identified via monthly alerts (up until April 2023) and the project stakeholder group (patient/carers, content experts and multidisciplinary practitioners).
RESULTS
130 documents were included (86 research, 22 literature reviews, 22 grey literature). The programme theory identified intervention strategies most likely to support integration of PC and HF services. These included protected time for evidence-based PC and HF education from undergraduate/postgraduate level and continuing professional practice; choice of educational setting (eg, online, face-to-face or hybrid); increased awareness and seeing benefits of PC for HF management; conveying the emotive and intellectual need for integrating PC and HF via credible champions; and prioritising PC and HF guidelines in practice.
CONCLUSIONS
The review findings outline the required steps to take to increase the likelihood that all key players have the capacity, opportunity and motivation to integrate PC into HF management.
PROSPERO REGISTRATION NUMBER
CRD42021240185.
Topics: Humans; Palliative Care; Heart Failure
PubMed: 38097362
DOI: 10.1136/openhrt-2023-002438 -
Annals of Palliative Medicine Nov 2023The delivery of comprehensive cancer care within a progressively intricate healthcare environment requires oncology providers to become well-versed in the integration of... (Review)
Review
The delivery of comprehensive cancer care within a progressively intricate healthcare environment requires oncology providers to become well-versed in the integration of palliative care (PC). Moreover, as healthcare professionals are urged to prioritize the individual preferences of patients and their families who confront life-limiting illnesses, it has become evident that oncology patients and their families have identified their psychosocial care needs as multifaceted and distinct, calling for specialized attention from care providers. Nevertheless, this is a skill that can be acquired through learning and practice. The landscape of PC is rapidly changing, with paradigm shifting studies highlighting the importance of early concurrent palliative and oncology inpatient and outpatient care for those with new advanced cancer diagnosis. Early concurrent care can notably improve quality of life (QoL), symptom control, patient and caregiver satisfaction, reduce costs and even improve survival. There is no longer a question of if PC should be offered, but instead when referral should be completed, what is the optimal model for service delivery and what barriers are present to achieve concurrent care. Conceptual models have been identified for optimal integrated palliative and oncology care delivery. In order to provide the best integrated care however, multiple obstacles need to be overcome. This narrative review discusses the importance of early integrated oncology and PC for patients with advanced cancer diagnosis, as well as the barriers to the integration of these specialties and potential models for delivery.
Topics: Humans; Palliative Care; Quality of Life; Neoplasms; Medical Oncology; Inpatients
PubMed: 37872127
DOI: 10.21037/apm-22-1154 -
The American Journal of Hospice &... Nov 2023To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke... (Review)
Review
To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.
Topics: Humans; COVID-19; Hospice and Palliative Care Nursing; Palliative Care; Pandemics; Terminal Care
PubMed: 36503251
DOI: 10.1177/10499091221145202 -
Neurocritical Care Dec 2023Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide and many patients with TBI require intensive care unit (ICU) management. When...
Traumatic brain injury (TBI) is a significant cause of mortality and morbidity worldwide and many patients with TBI require intensive care unit (ICU) management. When facing a life-threatening illness, such as TBI, a palliative care approach that focuses on noncurative aspects of care should always be considered in the ICU. Research shows that neurosurgical patients in the ICU receive palliative care less frequently than the medical patients in the ICU, which is a missed opportunity for these patients. However, providing appropriate palliative care to neurotrauma patients in an ICU can be difficult, particularly for young adult patients. The patients' prognoses are often unclear, the likelihood of advance directives is small, and the bereaved families must act as decision-makers. This article highlights the different aspects of the palliative care approach as well as barriers and challenges that accompany the TBI patient population, with a particular focus on young adult patients with TBI and the role of their family members. The article concludes with recommendations for physicians for effective and adequate communication to successfully implement the palliative care approach into standard ICU care and to improve quality of care for patients with TBI and their families.
Topics: Young Adult; Humans; Palliative Care; Intensive Care Units; Brain Injuries, Traumatic; Family; Prognosis
PubMed: 37173560
DOI: 10.1007/s12028-023-01717-1 -
Palliative Medicine Jul 2023
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Telemedicine
PubMed: 37387223
DOI: 10.1177/02692163231182461 -
BMJ Supportive & Palliative Care Jan 2024The utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The utilisation of palliative sedation is often favoured by patients approaching end of life due to the presence of multiple difficult-to-manage symptoms during the terminal stage. This study aimed to identify the determinants of the use of palliative sedation.
METHODS
To identify pertinent observational studies, a comprehensive search was performed in PubMed, Embase, Cochrane Library, and PsycINFO databases from their inception until March 2022. The methodological quality of the chosen prospective and retrospective cohort studies was assessed using the Newcastle Ottawa Scale, while the Agency for Healthcare Research and Quality was used to evaluate the methodological quality of the selected cross-sectional studies. For each potential determinant of interest, the collected data were synthesised and analysed, and in cases where data could not be combined, a narrative synthesis approach was adopted.
RESULTS
A total of 21 studies were analysed in this research, consisting of 4 prospective cohort studies, 7 retrospective cohort studies, and 10 cross-sectional studies. The findings indicated that several determinants were significantly associated with palliative sedation. These determinants included younger age, male gender, presence of tumours, dyspnoea, pain, delirium, making advanced medical end-of-life decisions, and dying in a hospital setting.
CONCLUSIONS
The findings of our review could help physicians identify patients who may need palliative sedation in advance and implement targeted interventions to reverse refractory symptoms, develop personalized palliative sedation programs, and ultimately improve the quality of palliative care services.
TRIAL REGISTRATION
PROSPERO registration number CRD42022324720.
Topics: Humans; Death; Palliative Care; Palliative Medicine; Terminal Care; Deep Sedation
PubMed: 37553203
DOI: 10.1136/spcare-2022-004085 -
Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Dec 2023Integrative palliative care is the early intervention of palliative medicine for the patients with serious illness,jointly providing care with the patients' primary care...
Integrative palliative care is the early intervention of palliative medicine for the patients with serious illness,jointly providing care with the patients' primary care team.By literature review and real-life experience study,we conclude that the integrative palliative care can make effective use of existing healthcare resources and provide the original treatment team with palliative medical technical support,thereby improving the patients' quality of life.The healthcare institutions need to choose an appropriate care model on the basis of evaluating its own strengths and weaknesses.The palliative care team needs to establish a long-term and sustainable relationship with each department in the hospital to provide patients with a safer and more effective medical experience.
Topics: Humans; Palliative Care; Quality of Life; Hospitals
PubMed: 38173107
DOI: 10.3881/j.issn.1000-503X.15812 -
Respiratory Medicine 2023Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as... (Review)
Review
INTRODUCTION
Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as their families, face considerable physical, emotional and social challenges. Palliative care might be a valuable approach to address their complex needs, but evidence to prove this is still scarce.
OBJECTIVES
This systematic review aimed to study the effectiveness of palliative care interventions in health-related outcomes (quality of life, symptom control, symptom burden, psychological well-being, advance care planning, use of health services, and survival) in chronic respiratory patients.
METHODS
Pubmed, Cochrane and Web of Science were searched for trials published in the last 10 years, comparing palliative care interventions to usual care, in patients with chronic respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed.
RESULTS
Eight studies were included, seven randomized controlled trials and one cluster-controlled trial; the former with moderate risk of bias and the latter with high risk of bias. Findings revealed that palliative interventions improve breathlessness control and advance care planning. There were no significant differences for the other outcomes.
CONCLUSIONS
Palliative care appears to have a beneficial effect on breathlessness, one of the most distressing symptoms in patients suffering from chronic respiratory diseases and allows for advanced care planning. Additional research, with more robust trials, is needed to draw further conclusions about other health-related outcomes.
Topics: Humans; Palliative Care; Quality of Life; Advance Care Planning; Dyspnea; Anxiety
PubMed: 37717791
DOI: 10.1016/j.rmed.2023.107411 -
Journal of Clinical Nursing Jul 2023To describe the quality of information coming from previous care units to palliative care.
AIMS AND OBJECTIVES
To describe the quality of information coming from previous care units to palliative care.
BACKGROUND
Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi-professional perspective on the information quality coming to palliative care.
DESIGN
Descriptive qualitative study.
METHODS
Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used.
RESULTS
Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub-categories followed by narratives of their content.
CONCLUSIONS
This study provides new knowledge on the quality of information coming to palliative care from a multi-professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement.
RELEVANCE TO CLINICAL PRACTICE
The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality.
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Qualitative Research; Physicians; Narration
PubMed: 35844084
DOI: 10.1111/jocn.16453