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Current Oncology (Toronto, Ont.) Jun 2024Early integrated palliative care (EIPC) for patients with advanced cancers requires the involvement of family doctors (FDs) and oncologists. We compared attitudes...
Early integrated palliative care (EIPC) for patients with advanced cancers requires the involvement of family doctors (FDs) and oncologists. We compared attitudes between patients and their providers regarding the delivery of EIPC. Patients with newly diagnosed incurable gastrointestinal (GI) cancer at a tertiary cancer centre in Ontario, Canada, were surveyed using a study-specific instrument regarding the importance of and preferences for accessing support across eight domains of palliative care. Physicians within the circle of care completed a parallel survey for each patient. The concordance between patient and physician responses was analyzed. A total of 66 patients were surveyed (median age 69, 35% female). All had an oncologist, 12% had a specialist palliative care provider (SPC), and 97% had an FD, but only 41% listed the FD as part of the care team. In total, 95 providers responded (oncologist = 68, FD = 21, SPC = 6; response rate 92%; 1-3 physician responses per patient). Disease management and physical concerns were most important to patients. Patients preferred to access care in these domains from oncologists or SPCs. For all other domains, most patients attributed primary responsibility to self or family rather than any healthcare provider. Thus, concordance was poor between patient and physician responses. Across most domains of palliative care, we found low agreement between cancer patients and their physicians regarding responsibilities for care, with FDs appearing to have limited involvement at this stage.
Topics: Humans; Palliative Care; Female; Male; Gastrointestinal Neoplasms; Aged; Middle Aged; Prospective Studies; Surveys and Questionnaires; Patient Preference; Attitude of Health Personnel; Aged, 80 and over; Adult; Ontario
PubMed: 38920736
DOI: 10.3390/curroncol31060253 -
Current Oncology (Toronto, Ont.) May 2024Effective cancer pain management is essential for improving the quality of life of patients. However, the use of analgesics is often suboptimal due to various...
BACKGROUND
Effective cancer pain management is essential for improving the quality of life of patients. However, the use of analgesics is often suboptimal due to various patient-related barriers. This study aims to explore the perceptions, knowledge, and attitudes toward analgesic use among cancer patients in Oman, which may influence their pain management strategies.
METHODS
In a cross-sectional study, we assessed 68 cancer patients undergoing pain management at an inpatient cancer clinic of a tertiary hospital in Oman from a pool of 154 eligible participants. The Barriers Questionnaire (BQ) and the Patient Pain Questionnaire (PPQ), both Arabic versions, were administered to evaluate the patients' barriers to cancer pain management. The study period and the criteria for patient selection are specified.
RESULTS
With a participation rate of 44.2% and a female-to-male ratio of 2.28:1, the mean score on the BQ was 2.52 (SD 0.84), indicating a moderate level of perceived barriers. Patients' scores suggested notable barriers, with older patients exhibiting reluctance toward analgesics for fear of masking symptoms and female patients expressing greater concerns about developing drug tolerance.
CONCLUSION
The findings highlight significant attitudinal barriers to effective cancer pain management in Oman, notably a prevalent fear of medication tolerance. The study stresses on the need for targeted patient education and the correction of misconceptions. It also points to the influence of cultural and religious beliefs on patient responses, advocating for the implementation of culturally sensitive, evidence-based pain management guidelines, and the support of multidisciplinary palliative care teams.
Topics: Humans; Male; Female; Oman; Cancer Pain; Palliative Care; Pain Management; Middle Aged; Cross-Sectional Studies; Adult; Surveys and Questionnaires; Aged; Neoplasms; Analgesics; Health Knowledge, Attitudes, Practice
PubMed: 38920709
DOI: 10.3390/curroncol31060225 -
Annali Dell'Istituto Superiore Di Sanita 2024In western countries, the increasing life expectancy and the growing number of individuals with advanced chronic conditions have resulted in a greater demand for...
BACKGROUND
In western countries, the increasing life expectancy and the growing number of individuals with advanced chronic conditions have resulted in a greater demand for palliative care. Specifically, Italy has witnessed substantial growth in the palliative care field, marked by the establishment of Palliative Care Networks and an academic fellowship program in 2022. To further enhance this field, it is crucial to conduct high-quality scientific research that produces results applicable in clinical practice.
AIM
This article explores challenges and potential solutions in conducting effective palliative care research, considering sample definition, research settings, outcomes, and ethical concerns. While focusing on the Italian context, the presented research framework can be applied to other contexts and regions.
RESULTS
Palliative care research is complex and challenging due to its holistic approach, which encompasses various vital dimensions of patients and their families, including physical, emotional, and social needs. The Italian and worldwide experience provides insights into managing these challenges and enhancing the methodological rigor of studies and the practical application of research findings.
CONCLUSIONS
This article emphasizes the importance of developing protocols tailored to palliative care's unique characteristics, and the necessity of dedicated funding for palliative care research, calling for increased support and recognition. The article advocates for improvement of the quality and relevance of palliative care studies, promoting better patient outcomes and enhanced caregiving.
Topics: Italy; Palliative Care; Humans; Biomedical Research; Research Design
PubMed: 38920260
DOI: 10.4415/ANN_24_01_09 -
Canadian Oncology Nursing Journal =... 2023Patients with severe mental illness often present with more advanced cancer at diagnosis, experience poorer quality of care, receive fewer medical treatments, have...
Patients with severe mental illness often present with more advanced cancer at diagnosis, experience poorer quality of care, receive fewer medical treatments, have higher overall disease mortality, and are less likely to access timely palliative care when compared to patients without severe mental illness. Research findings have shown that early involvement of specialized palliative care services for patients with advanced cancer improves quality of life, increases satisfaction with care, and mitigates depression. This case study will highlight the spectrum of challenges in caring for patients with a severe mental illness and advanced cancer from the perspective of an inpatient palliative care consult team.
PubMed: 38919897
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2023Having advanced care planning conversations with patients and/or their substitute decision maker has been shown to lead to many benefits, including aligning a patient's...
Having advanced care planning conversations with patients and/or their substitute decision maker has been shown to lead to many benefits, including aligning a patient's priorities and health expectations with his or her wishes. Typically, these conversations have been held with physicians, but have evolved over time to also be incorporated into the roles of other healthcare professionals. Advanced practice nurses who are trained to use a framework or an approach when having such conversations has been shown to have merit. As a result, advanced practice nurses are well positioned to be leaders in facilitating such conversations. In this project, the documentation notes of one advanced practice nurse on an in-patient palliative care team were examined, using the , to evaluate the Advanced Practice Nurse's contribution to the process of holding advanced planning conversations with patients.
PubMed: 38919894
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2023Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and...
Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and genomics. In spite of this, cancer remains the leading cause of death in Canada, with an estimated two in five Canadians expected to be diagnosed with cancer and one in four Canadians expected to die of cancer in their lifetime. Although Canada has a publicly funded, universal healthcare system, profound inequities exist across the country. Such inequities are often due to a multitude of intersecting factors. The focus of this paper is to review the impact of rurality on cancer care. People residing in rural and remote regions are known to have reduced access to and availability of cancer care, from prevention through diagnosis, treatment, follow-up, and palliative care. Potential strategies to mitigate the challenges associated with rurality will be discussed, including an overview of the role that nurses can play in addressing the needs of patients in rural regions. Oncology nurses are well suited to help support patients, their loved ones, and healthcare colleagues in rural settings with a view to helping improve equity in access to care, quality of care, and outcomes of care for all Canadians.
PubMed: 38919591
DOI: No ID Found -
Canadian Oncology Nursing Journal =... 2023Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline,...
BACKGROUND
Glioblastoma Multiforme is a deadly brain cancer that is very challenging for patients and their families. It is associated with rapid progression, cognitive decline, and a low survival rate.
OBJECTIVE
To determine whether deceased Glioblastoma Multiforme patients had received follow-up service from the palliative care team before their death, whether invasive measures had been reduced, and whether the last antineoplastic treatment was given within 14-30 days before death.
METHOD
A retrospective study utilizing chart data from January 2020 to March 2022 from an institutional project. Data were gathered to reflect selected indicators of quality of care for palliative care patients.
RESULTS
Of the 30 hospitalized patients with Glioblastoma Multiforme who had died while in hospital, 50% had received support from the palliative care team. Two patients (6.7%) had undergone antineoplastic treatment in the last 14 days of life and 13 (43.3%) had an order limiting invasive measures defined in the last two weeks of life.
CONCLUSION
In half of the patients monitored by a palliative care team, antineoplastic treatment and limitation of invasive measures occurred in the last 14 days of life. This may be associated with increased suffering of patients, family members, and professionals. Discussions about end-of-life care-related choices and goals of care need to be respected.
PubMed: 38919587
DOI: 10.5737/23688076334436 -
Canadian Oncology Nursing Journal =... 2023To explore the impact of implementation of a symptom screening and supportive/palliative care referral pathway in patients newly referred to a Canadian gastrointestinal...
PURPOSE
To explore the impact of implementation of a symptom screening and supportive/palliative care referral pathway in patients newly referred to a Canadian gastrointestinal medical oncology clinic.
METHODS
Eighty-eight subjects were recruited in each study arm. Intervention subjects were assessed by a member of the supportive/palliative care team if they had a severity score of >3/10 on the Edmonton Symptom Assessment System. Controls received normal care, including discretionary referral. Symptom severity was assessed over the subsequent five months. Data on survival, care setting of death (home, hospice or hospital) and long-term resource use were also collected.
RESULTS
Screening led to 141 specialist supportive/palliative care visits in the intervention arm versus only nine in the control arm. There were, however, no subsequent significant differences in symptom severity or the long-term outcomes measured. Many patients identified by the >3/10 severity threshold did not need/want specialist supportive/palliative care referral, and those with severe distress were either identified by the oncology team already or were too unwell or overwhelmed to participate in the study. The specialist service was not overwhelmed. Important considerations on timing and mode of administration of screening tools were revealed.
CONCLUSION
Routine symptom screening can be burdensome for oncology patients and needs to be as simple as possible. Triaging positive screens is an important role for oncology nurses. Investment in training oncology teams to manage uncomplicated distress in the oncology clinic allows for optimal use of scarce supportive/palliative care specialist resources for patients with complex needs.
PubMed: 38919584
DOI: 10.5737/23688076334452 -
Frontiers in Endocrinology 2024Medullary thyroid carcinoma (MTC) accounts for only 3% of all thyroid carcinomas: 75% as sporadic MTC (sMTC) and 25% as hereditary MTC (hMTC) in the context of multiple... (Review)
Review
Medullary thyroid carcinoma (MTC) accounts for only 3% of all thyroid carcinomas: 75% as sporadic MTC (sMTC) and 25% as hereditary MTC (hMTC) in the context of multiple endocrine neoplasia type 2 (MEN2). Early diagnosis is possible by determining the tumour marker calcitonin (Ctn) when clarifying nodular goitre and by detecting the mutation in the proto-oncogene RET in the MEN2 families. If the Ctn level is only slightly elevated, up to 30 pg/ml in women and up to 60 pg/ml in men, follow-up checks are advisable. At higher levels, surgery should be considered; at a level of > 100 pg/ml, surgery is always advisable. The treatment of choice is total thyroidectomy, possibly with central lymphadenectomy. In the early stage, cure is possible with adequate surgery; in the late stage, treatment with tyrosine kinase inhibitors is an option. RET A mutation analysis should be performed on all patients with MTC. During follow-up, a biochemical distinction is made between: healed (Ctn not measurably low), biochemically incomplete (Ctn increased without tumour detection) and structural tumour detection (metastases on imaging). After MTC surgery, the following results should be available for classification in follow-up care: (i) histology, Ctn immunohistology if necessary, (ii) classification according to the pTNM scheme, (iii) the result of the RET analysis for categorisation into the hereditary or sporadic variant and (iiii) the postoperative Ctn value. Tumour progression is determined by assessing the Ctn doubling time and the RECIST criteria on imaging. In most cases, "active surveillance" is possible. In the case of progression and symptoms, the following applies: local (palliative surgery, radiotherapy) before systemic (tyrosine kinase inhibitors).
Topics: Humans; Thyroid Neoplasms; Proto-Oncogene Mas; Carcinoma, Medullary; Multiple Endocrine Neoplasia Type 2a; Proto-Oncogene Proteins c-ret; Thyroidectomy; Mutation; Calcitonin; Biomarkers, Tumor; Carcinoma, Neuroendocrine
PubMed: 38919477
DOI: 10.3389/fendo.2024.1412942 -
Journal of Anaesthesiology, Clinical... 2024Squint surgery is a risk factor for postoperative vomiting (POV) in children. This study was designed to compare the incidence of POV in children undergoing strabismus...
BACKGROUND AND AIMS
Squint surgery is a risk factor for postoperative vomiting (POV) in children. This study was designed to compare the incidence of POV in children undergoing strabismus surgery under balanced anesthesia with sevoflurane versus intravenous anesthesia with propofol.
MATERIAL AND METHODS
In this prospective randomized controlled study conducted in a tertiary care ophthalmology hospital, 70 ASA I-II children aged 1-12 years undergoing strabismus surgery were randomized to two groups -Group S (sevoflurane-based anesthesia) and Group P (propofol-based anesthesia) for maintenance. The surgical details, intraoperative hemodynamic parameters, recovery characteristics, and emergence delirium were recorded. Any episode of postoperative vomiting in the 0-2 hours, 2-6 hours, and 6-24 hours period was noted. Rescue antiemetic was administered if there was more than one episode of vomiting.
RESULTS
Both the groups were similar with respect to demographic and surgical details. The average duration of surgery was 118.2 ± 41.88 min in group S and 137.32 ± 39.09 min in group P ( = .05). Four children in group S (11.4%) and one child in group P (2.9%) had POV in the first 24 hours but this was not statistically significant ( = .36). The median time to discharge from post anesthesia care unit was significantly less ( = .02) in the P group (50 min) than in the S group (60 min).
CONCLUSION
Propofol-based anesthesia does not offer advantage over sevoflurane, in reducing POV after squint surgery, when dual prophylaxis with dexamethasone and ondansetron is administered. It, however, reduces the duration of stay in the post anesthesia care unit.
PubMed: 38919441
DOI: 10.4103/joacp.joacp_363_22