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CMAJ : Canadian Medical Association... Oct 2020
Topics: COVID-19; Decision Making, Shared; Health Care Rationing; Health Equity; Humans; Palliative Care; Pandemics; Patient Care Planning; Surge Capacity; Terminal Care; Withholding Treatment
PubMed: 33077529
DOI: 10.1503/cmaj.200465-f -
Bulletin Du Cancer Sep 2019Early palliative care is now recommended in international guidelines. A meta-analyze combining seven randomized studies has been published in 2007. It confirms that... (Review)
Review
Early palliative care is now recommended in international guidelines. A meta-analyze combining seven randomized studies has been published in 2007. It confirms that early palliative care improves patient's quality of life and reduces symptom burden. There is also a trend for the reduction of depressive disorder and the increase of overall survival. Other studies show that early palliative care improves quality of life of patient's relatives and reduces end of life care aggressiveness. Most of the time, early palliative care is introduced as soon as the diagnosis of advanced cancer is made, and the precise referral criteria need to be addressed. Other studies have assessed the palliative care consultation; patient-centered care, focusing on symptom management, filling information and education needs about illness and prognosis, helping psychologic adaptation and coping.
Topics: Cancer Survivors; Depression; Humans; Medical Oncology; Meta-Analysis as Topic; Neoplasms; Palliative Care; Patient Education as Topic; Quality of Life; Randomized Controlled Trials as Topic; Terminal Care
PubMed: 31174856
DOI: 10.1016/j.bulcan.2019.04.006 -
Annals of Palliative Medicine Sep 2023The compassionate communities (CC) movement is an emergent health promotion approach to palliative care that views illness, dying, death, and loss as universal...
BACKGROUND
The compassionate communities (CC) movement is an emergent health promotion approach to palliative care that views illness, dying, death, and loss as universal experiences, and challenges the notion that disease precludes one from health care attention and interest. It seeks to normalise these phenomena and reorientate care to communities by activating naturally occurring networks and mobilising community resources. A surge of interventions aligned with the ethos of CC has been observed over the last decade. This scoping review seeks to synthesise what is currently known about the design, efficacy, and impact of CC interventions.
METHODS
Cochrane, PubMed, Scopus, and Web of Science were systematically searched. Hand searching was performed on three key journals, reference lists and citation lists of included articles, and relevant review articles. Two levels of analysis were conducted. First, a numerical presentation of the characteristics of CC interventions. Second, a thematically orientated narrative analysis of intervention efficacy.
RESULTS
A total of 1,882 records were screened; 62 papers were included. Most were implemented by palliative care organisations in Europe, North America, and Australia. Included studies were mapped against Clark et al.'s taxonomy of end-of-life interventions: educational (n=17); service (n=20); clinical (n=3); cultural (n=4); and multi-dimensional (n=18) interventions are discussed. While preliminary findings are positive, claims of efficacy are limited due to methodological paucity in the field.
CONCLUSIONS
We argue that the field would benefit from more transparent and theoretically driven CC interventions in order to explicate the mechanism(s) for successful intervention implementation.
Topics: Humans; Palliative Care; Australia; Europe
PubMed: 37475658
DOI: 10.21037/apm-22-867 -
Supportive Care in Cancer : Official... Feb 2023On the basis of substantial evidence demonstrate that palliative care combined with standard care improves patient, caregiver, and society outcomes, we have developed a... (Observational Study)
Observational Study
BACKGROUND
On the basis of substantial evidence demonstrate that palliative care combined with standard care improves patient, caregiver, and society outcomes, we have developed a new healthcare model called radiotherapy and palliative care (RaP) outpatient clinic were a radiation oncologist and a palliative care physician make a joint evaluation of advanced cancer patients.
METHODS
We performed a monocentric observational cohort study on advanced cancer patients referred for evaluation at the RaP outpatient clinic. Measures of quality of care were carried out.
RESULTS
Between April 2016 and April 2018, 287 joint evaluations were performed and 260 patients were evaluated. The primary tumor was lung in 31.9% of cases. One hundred fifty (52.3%) evaluations resulted in an indication for palliative radiotherapy treatment. In 57.6% of cases was used a single dose fraction of radiotherapy (8 Gy). All the irradiated cohort completed the palliative radiotherapy treatment. An 8% of irradiated patients received the palliative radiotherapy treatment in the last 30 days of life. A total of 80% of RaP patients received palliative care assistance until the end of life.
CONCLUSION
At the first descriptive analysis, the radiotherapy and palliative care model seem to respond to the need of multidisciplinary approach in order to obtain an improvement on quality of care for advanced cancer patients.
Topics: Humans; Palliative Care; Neoplasms; Radiation Oncology; Ambulatory Care Facilities; Delivery of Health Care
PubMed: 36809496
DOI: 10.1007/s00520-023-07584-y -
Seminars in Respiratory and Critical... Dec 2023Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature... (Review)
Review
Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care revolves around symptom palliation and reducing psychosocial disease burden for a dying patient and entails advanced care planning that are often challenging. Thus, support from palliative care specialist becomes extremely important in these patients. Early introduction to palliative care in patients with high symptom burden and psychosocial suffering is suggested. Despite of the benefits of an early intervention, palliative care remains underutilized in patients with PAH, and this significantly raises issues around end-of-life care in PAH. In this review, we will discuss the opportunities offered and the existing barriers in addressing high symptom burden and end-of-life care issues. We will focus on the current evidence, identify areas for future research, and provide a call-to-action for better guidance to PAH specialists in making timely, appropriate interventions that can help mitigate end-of-life care issues.
Topics: Humans; Palliative Care; Pulmonary Arterial Hypertension; Quality of Life; Terminal Care; Death
PubMed: 37459883
DOI: 10.1055/s-0043-1770124 -
Annals of Palliative Medicine Feb 2022Surgeons are frequently consulted for assistance in the palliative management of patients, and surgery is an essential tool in the armamentarium of comprehensive...
Surgeons are frequently consulted for assistance in the palliative management of patients, and surgery is an essential tool in the armamentarium of comprehensive palliative care. Palliative surgical consults are some of the most challenging surgical consults, not only for technical reasons, but also because of the (usually) higher odds of morbidity or mortality, often in the setting of a limited life expectancy. Surgery is also often seen as the last possibility of hope, which can place a great emotional burden on the surgeon. Surgeons find themselves torn between concern about causing more harm than good, and not wanting to miss an opportunity to help. Although there is a growing body of literature around the outcomes for palliative surgery and patient selection, most palliative surgery decisions are still not evidence-based, but rather experienced-based. Because palliative surgical decision-making relies heavily on the surgeon's experience and risk (and/or regret) tolerance, surgeons often find themselves called upon to explain highly complex and nuanced concepts with existential outcomes to people who are desperate for hope. Even for the best communicators, achieving the goals of effective communication can be challenging in these situations, and in some instances, may seem unachievable. This article examines the communication challenges faced by surgeons in the palliative surgical setting and recommends specific strategies and approaches to help address those challenges and facilitate effective communication. Lastly, it considers the most necessary element of care for most patients and surgeons in the palliative setting: hope.
Topics: Communication; Humans; Palliative Care; Patient Selection; Referral and Consultation
PubMed: 35016524
DOI: 10.21037/apm-20-2590 -
Healthcare Quarterly (Toronto, Ont.) Apr 2021We need to support and educate palliative care specialists and generalist providers, especially family physicians, on how to integrate an early palliative care approach...
We need to support and educate palliative care specialists and generalist providers, especially family physicians, on how to integrate an early palliative care approach into care for those with a serious illness. However, there are very few care providers compared to the number of patients and caregivers in society. To increase access to palliative care at a population level, we need a waiting room revolution, one where patients and families shift from being passive to being active in shaping their experience with serious illness. A co-design approach with patients and families can help overcome barriers to accessing palliative care and improve the overall experience.
Topics: Canada; Family; Health Services Accessibility; Humans; Palliative Care; Patient Participation; Physicians, Primary Care
PubMed: 33864434
DOI: 10.12927/hcq.2021.26472 -
PloS One 2020Palliative care is an essential part of medical practice but it remains limited, inaccessible, or even absent in low and middle income countries.
BACKGROUND
Palliative care is an essential part of medical practice but it remains limited, inaccessible, or even absent in low and middle income countries.
OBJECTIVES
To evaluate the general knowledge, attitudes, and practices of Mozambican physicians on palliative care.
METHODS
A cross-sectional observational study was conducted between August 2018 and January 2019 in the 3 main hospitals of Mozambique, in addition to the only hospital with a standalone palliative care service. Data was collected from a self-administered survey directed to physicians in services with oncology patients.
RESULTS
Two hundred and seven out of 306 physicians surveyed answered the questionnaire. The median physician age was 38 years. Fifty-five percent were males, and 49.8% residents. The most common medical specialty was surgery with 26.1%. Eighty percent of physicians answered that palliative care should be provided to patients when no curative treatments are available; 87% believed that early integration of palliative care can improve patients' quality of life; 73% regularly inform patients of a cancer diagnosis; 60% prefer to inform the diagnosis and prognosis to the family/caregivers. Fifty percent knew what a "do-not-resuscitate" order is, and 51% knew what palliative sedation is. Only 25% of the participants answered correctly all questions on palliative care general knowledge, and only 24% of the participants knew all answers about euthanasia.
CONCLUSIONS
Mozambican physicians in the main hospitals of Mozambique have cursory knowledge about palliative care. Paternalism and the family-centered model are the most prevalent. More interventions and training of professionals are needed to improve palliative care knowledge and practice in the country.
Topics: Adult; Aged; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Mozambique; Palliative Care; Surveys and Questionnaires
PubMed: 32833987
DOI: 10.1371/journal.pone.0238023 -
JCO Global Oncology Jan 2023Palliative care in Sarawak is mainly provided by health care professionals with limited formal training in palliative care. Therefore, in 2020, collaborative work...
PURPOSE
Palliative care in Sarawak is mainly provided by health care professionals with limited formal training in palliative care. Therefore, in 2020, collaborative work between Sarawak General Hospital, University Malaysia Sarawak, and ASCO began. This study reports on the outcome of this collaboration.
METHODS
The collaboration was initiated with the first ASCO Palliative Care e-course, Train the Trainer program, International Development and Education Award-Palliative Care and translation of ASCO Palliative Care Interdisciplinary Curriculum resources.
RESULTS
This collaboration has resulted in the change of practice of palliative care among the oncology team of Sarawak General Hospital.
CONCLUSION
It encourages more timely palliative care referrals to ensure that patients with complex physical, psychosocial, and spiritual needs have the necessary input and support from the palliative care team throughout the course of patients' illnesses.
Topics: Humans; Palliative Care; Medical Oncology; Curriculum; Health Personnel
PubMed: 36630666
DOI: 10.1200/GO.22.00351 -
Perspectives in Biology and Medicine 2020Doctors often focus on the science of medicine involved in matters of reproductive health and childbirth, at times to the exclusion of the psychosocial and spiritual...
Doctors often focus on the science of medicine involved in matters of reproductive health and childbirth, at times to the exclusion of the psychosocial and spiritual dimensions of health. Pregnancy and childbirth are clothed in mystery when it comes to the question of why a pregnancy goes well or is fraught with complications. And while explanations may abound in this age of increasing genetic understanding, the meaning attached to these matters is beyond the scope of medicine alone-especially when the newborn's very survival is in question. Perinatal palliative care can bring solace to such troubling realities.
Topics: Catholicism; Congresses as Topic; Female; Humans; Palliative Care; Perinatal Care; Perinatal Death; Pregnancy; Pregnancy Complications; Prenatal Diagnosis
PubMed: 33416632
DOI: 10.1353/pbm.2020.0046