-
Clinical Medicine (London, England) Mar 2024Palliative care (PC) defined as 'an approach improving the quality of life of patients and their families facing problems associated with life-limiting illness, through... (Review)
Review
Palliative care (PC) defined as 'an approach improving the quality of life of patients and their families facing problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual' aims to enhance the improve the remaining time that patients have, emphasising choice for patients and families. Patients with neurological disease such as Parkinson's (PD) and motor neurone disease (MND) benefit from PC earlier in disease with increasing emphasis over time. Understanding and communicating uncertain trajectories, honest prognostic communication when patients are ready and careful symptom control has been shown to enhance quality of life in patients and caregivers, giving greater autonomy to these patients when supported in decision-making by a palliative approach. Although obstacles to palliative care are frequent, there are strategies which can help overcome them.
Topics: Humans; Palliative Care; Quality of Life; Motor Neuron Disease
PubMed: 38570095
DOI: 10.1016/j.clinme.2024.100038 -
Current Problems in Pediatric and... Jan 2024Despite the significant growth and development of pediatric palliative care worldwide, significant challenges remain. One of those challenges is shared decision-making,...
Despite the significant growth and development of pediatric palliative care worldwide, significant challenges remain. One of those challenges is shared decision-making, by which parents, families and professionals all work together to develop a plan of care that reflects both the medical facts and the patient's family's values. Shared decision-making about palliative care and about death and dying may mean different things in different cultures and countries. It is therefore important to learn and compare practices around the world.
Topics: Child; Humans; Palliative Care; Parents; Communication; Decision Making
PubMed: 38155022
DOI: 10.1016/j.cppeds.2023.101552 -
Palliative care interventions for patients with head and neck cancer: protocol for a scoping review.BMJ Open Nov 2023A head and neck cancer (HNC) diagnosis significantly impacts a patient's quality of life (QOL). Palliative care potentially improves their QOL. We will conduct a scoping...
INTRODUCTION
A head and neck cancer (HNC) diagnosis significantly impacts a patient's quality of life (QOL). Palliative care potentially improves their QOL. We will conduct a scoping review to identify existing knowledge about palliative care interventions for patients with HNC.
METHODS AND ANALYSIS
This scoping review was designed in accordance with the JBI Manual for Evidence Synthesis: Scoping Reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Our eligibility criteria follow the Population, Intervention, Comparison or Control, Outcomes and Study characteristics framework. The population is adult patients with locally advanced, metastatic, unresectable and/or recurrent HNC. We include peer-reviewed journal articles and articles in the press, in English, reporting on palliative care interventions with at least two of the eight National Consensus Project on Clinical Practice Guidelines for Quality Palliative Care domains; studies with and without comparators will be included. The outcomes are patient QOL (primary) and symptom severity, patients' satisfaction with care, patients' mood, advance care planning and place of death (secondary). We developed a search strategy across ten databases, to be searched from the inception to 11 September 2023: Medline ALL (Medline and EPub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase Classic+Embase, Emcare and PsycINFO all from the OvidSP platform; CINAHL from EBSCOhost, Scopus from Elsevier, Web of Science from Clarivate and Global Index Medicus from WHO. We will extract data using a piloted data form and analyse the data through descriptive statistics and thematic analysis.
ETHICS AND DISSEMINATION
Ethics approval is not needed for a scoping review. We will disseminate the findings to healthcare providers and policy-makers by publishing the results in a scientific journal.
Topics: Adult; Humans; Palliative Care; Quality of Life; Neoplasm Recurrence, Local; Head and Neck Neoplasms; Health Personnel; Research Design; Systematic Reviews as Topic; Review Literature as Topic
PubMed: 38011979
DOI: 10.1136/bmjopen-2023-078980 -
Journal of Tissue Viability Nov 2023Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative... (Review)
Review
BACKGROUND
Deciding whether to transition to wound palliation is challenging for health care professionals because there is no agreed definition or understanding of palliative wound care, including the goals, core elements and differences from general wound management.
OBJECTIVES
To conduct a scoping review with qualitative synthesis to define palliative wound care in terms of its conceptual framework, goals, principles, components, and differences from general wound management, and provide a new definition of palliative wound care based on this scoping review.
ELIGIBILITY CRITERIA
Published literature that refers to the definitions, concept, goals and core elements of palliative wound care using any methodological approach, without any time limits, published in English.
SOURCES OF EVIDENCE
The searches were conducted in CINAHL Complete via Ebsco, Medline via Ovid, Cochrane Library, Scopus, and Google Scholar.
CHARTING METHODS
A data extraction form was developed by the review team and used independently for data charting purposes. Braun and Clarke's six phases of thematic analysis guided the qualitative synthesis.
RESULTS
A total of 133 publications met the inclusion criteria. Three main themes were developed to define palliative wound care and understand its differences from general wound management: 1- Healing potential of wounds and patient vulnerability, 2- Understanding the impact on individuals and family to address needs, 3- Towards new goals and perspectives in approach to care.
CONCLUSIONS
Palliative wound care focuses on symptom management, comfort, and dignity, but does not always target the healing of the wound, which is the goal of general wound care. The needs of the individual and their family must be addressed by clinicians through the provision of care and support that takes into account the true meaning of living and dying with a palliative wound.
PROTOCOL REGISTRATION
A review protocol was developed but not registered.
Topics: Humans; Palliative Care; Terminal Care; Health Personnel
PubMed: 37482507
DOI: 10.1016/j.jtv.2023.07.002 -
A Systematic Approach to Assessing and Addressing Palliative Care Needs in an Outpatient Population.Journal of Pain and Symptom Management Sep 2023A critical frontier for palliative medicine is to develop systems to routinely and equitably address the palliative care (PC) needs of seriously ill populations.
CONTEXT/OBJECTIVES
A critical frontier for palliative medicine is to develop systems to routinely and equitably address the palliative care (PC) needs of seriously ill populations.
METHODS
An automated screen identified Medicare primary care patients who had serious illness based on diagnosis codes and utilization patterns. A stepped-wedge design was used to evaluate a six-month intervention through which a healthcare navigator assessed these seriously ill patients and their care partners for PC needs in the domains of 1) physical symptoms, 2) emotional distress, 3) practical concerns, and 4) advance care planning (ACP) via telephone surveys. Identified needs were addressed with tailored PC interventions.
RESULTS
A total of 292/2175 (13.4%) patients screened positive for serious illness. A total of 145 completed an intervention phase; 83 completed a control phase. Severe physical symptoms were identified in 27.6%, emotional distress in 57.2%, practical concerns in 37.2%, and ACP needs in 56.6%. Twenty-five intervention patients (17.2%) were referred to specialty PC compared to six control patients (7.2%). Prevalence of ACP notes increased 45.5%-71.7% (p = 0.001) during the intervention and remained stable during the control phase. Quality of life remained stable during the intervention and declined 7.4/10-6.5/10 (P =0.04) during the control phase.
CONCLUSION
Through an innovative program, patients with serious illness were identified from a primary care population, assessed for PC needs, and offered specific services to meet those needs. While some patients were appropriate for specialty PC, even more needs were addressed without specialty PC. The program resulted in increased ACP and preserved quality of life.
Topics: Aged; Humans; United States; Palliative Care; Quality of Life; Outpatients; Medicare; Hospice and Palliative Care Nursing; Advance Care Planning
PubMed: 37380147
DOI: 10.1016/j.jpainsymman.2023.06.024 -
Palliative Medicine Feb 2024
Topics: Humans; Palliative Care; Health Occupations; Hospice and Palliative Care Nursing; Education, Nursing; Health Services Research
PubMed: 38268060
DOI: 10.1177/02692163231219949 -
What is an "early palliative care" intervention? A scoping review of controlled studies in oncology.Cancer Medicine Dec 2023Early palliative care (EPC) has been advocated to improve cancer patients' health. However, EPC differs with regard to its elements and target groups. It is not known... (Review)
Review
INTRODUCTION
Early palliative care (EPC) has been advocated to improve cancer patients' health. However, EPC differs with regard to its elements and target groups. It is not known which parts of EPC contribute to effectiveness for which patient group. This scoping review provides a structured analysis of EPC interventions and outcome measures.
DESIGN
We searched EMBASE, MEDLINE, CINAHL, and CENTRAL up to February 2022. We included randomized controlled trials (RCT), nonrandomized trials, cohort studies (CS), and controlled before-after studies of EPC in adult patients in English, Dutch, and German language. Interventions had to be self-labeled as EPC. Screening and data extraction were performed by two raters. A structured analysis incorporating the TIDieR checklist was performed to describe the elements of the interventions.
RESULTS
We screened 2651 articles, resulting in 40 articles being included: 34 studies were RCT and six studies were CS with a mean sample size of 208 patients. Patients with pancreatic (n = 10) and lung cancer (n = 9) were most often included. Studies reported different reference points for the onset of EPC such as time after diagnosis of incurable cancer (n = 18) or prognosis (n = 9). Thirteen studies provided information about elements of EPC and eight studies about the control intervention. Most frequent elements of EPC were symptom management (n = 28), case management (n = 16), and advance care planning (ACP; n = 15). Most frequently reported outcome measures were health-related quality of life (n = 26), symptom intensity (n = 6), resource use, and the patient's mood (n = 4 each).
CONCLUSION
The elicited heterogeneity of ECP in combination with deficits of reporting are considerable barriers that should be addressed to further develop effective EPC interventions for different groups of cancer patients.
Topics: Adult; Humans; Affect; Lung Neoplasms; Palliative Care; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 37902232
DOI: 10.1002/cam4.6490 -
Journal of Pain and Symptom Management Dec 2023Volunteers in palliative care settings are an essential part of care provision for patients and those important to them. Effective collaboration between volunteers and... (Review)
Review
CONTEXT
Volunteers in palliative care settings are an essential part of care provision for patients and those important to them. Effective collaboration between volunteers and paid staff has been regarded as an important element of successful working, however, at times failures in coordination, information sharing and tensions within teams have been highlighted.
OBJECTIVES
To explore the views expressed by volunteers and paid staff about their experiences of working together in palliative care settings.
METHODS
A systematic exploration of qualitative research using a meta-ethnographic approach. PsycINFO, CINAHL, Medline Complete, and AMED databases were searched from inception to December 2021 for the concepts "volunteers" and "palliative care." Repeated in-depth reading and appraisal of papers identified metaphors and concepts, providing new interpretations.
RESULTS
Included papers (n = 14) enabled the construction of five storylines: 1) "we are the cake, and they are the cream": understanding the volunteer role-separate, but part of a whole. 2) "…we don't know what's wrong with people but sometimes we need to know": access to information and importance of trust. 3) "everybody looks out for each other": access to paid staff and their support. 4) "...we don't meddle in the medical": boundaries. 5) "it's the small things that the staff does for me that makes me feel good about my work": sense of value and significance.
CONCLUSIONS
For effective working relationships between paid staff and volunteers, proactive engagement, recognition of each other's role and contribution, mutual sharing of information, and intentional interaction between both groups is needed.
Topics: Humans; Palliative Care; Hospice and Palliative Care Nursing; Qualitative Research; Trust; Volunteers
PubMed: 37574093
DOI: 10.1016/j.jpainsymman.2023.08.004 -
Journal of Palliative Medicine Dec 2023This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published . That...
This report, signed by >170 scholars, clinicians, and researchers in palliative care and related fields, refutes the claims made by the previously published . That report attempted to argue that structural vulnerability was not a concern in the provision of assisted dying (AD) by a selective review of evidence in medical literature and population studies. It claimed that palliative care has its own safety concerns, and that "misuse" of palliative care led to reports of wrongful death. We and our signatories do not feel that the conclusions reached are supported by the evidence provided in the contested report. The latter concluded that the logical policy response would be to address the root causes of structural vulnerability rather than restrict access to AD. Our report, endorsed by an international community of palliative care professionals, believes that public policy should aim to reduce structural vulnerability and, at the same time, respond to evidence-based cautions about AD given the potential harm.
Topics: Humans; Palliative Care; Suicide, Assisted; Research Design; Medical Assistance
PubMed: 37955548
DOI: 10.1089/jpm.2023.0581 -
Current Treatment Options in Oncology Oct 2023Systemic anticancer therapy (SACT) includes different treatment modalities that can be effective in treating cancer. However, in the case of disease progression, cancers... (Review)
Review
Systemic anticancer therapy (SACT) includes different treatment modalities that can be effective in treating cancer. However, in the case of disease progression, cancers might become incurable and SACT might reach its limits. In the case of incurable cancers, SACT is often given in a palliative setting, with the goal of improving the patients' quality of life (QOL) and their survival. In contrast, especially for patients who approach end of life (EOL), such treatments might do more harm than good. Patients receiving EOL anticancer treatments often experience belated palliative care referrals. The use of systemic chemotherapy in patients with advanced cancer and poor prognosis approaching the EOL has been associated with significant toxicity and worse QOL compared to best supportive care. Therefore, the American Society of Clinical Oncology (ASCO) has discouraged this practice, and it is considered a metric of low-value care by Choosing Wisely (Schnipper et al. in J Clin Oncol 4;30(14):1715-24). Recommendations of the European Society for Medical Oncology (ESMO) suggest that especially chemotherapy and immunotherapy should be avoided in the last few weeks of the patients' lives. In this narrative review, we screened the current literature for the impact of SACT and factors predicting the use of SACT near the EOL with discussion on this topic.
Topics: Humans; Quality of Life; Neoplasms; Palliative Care; Medical Oncology; Death
PubMed: 37501037
DOI: 10.1007/s11864-023-01115-x