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Revista Brasileira de Enfermagem Jun 2016to analyze scientifi c articles published in international online journals about palliative care and spirituality. (Review)
Review
OBJECTIVE
to analyze scientifi c articles published in international online journals about palliative care and spirituality.
METHODS
an integrative literature review with data collected in September 2014 from the LILACS, SCIELO, MEDLINE/PubMed, and IBECS databases.
RESULTS
thirty-nine publications were identifi ed and their textual analysis facilitated through four thematic approaches: the meaning of spirituality in the context of palliative care; palliative care and spiritual support; spirituality and relief of pain and other symptoms in patients under palliative care; and instruments to evaluate the spiritual dimension of the scope of palliative care.
CONCLUSION
this study examined the relevance of the spiritual dimension in the care of patients with palliative care and the need for developing new studies to disseminate knowledge about this topic.
DESCRIPTORS
Palliative Care; Palliative Care at End of Live; Spirituality; Religion; Health.
Topics: Humans; Palliative Care; Spiritual Therapies; Spirituality
PubMed: 27355311
DOI: 10.1590/0034-7167.2016690324i -
Journal of the American College of... Oct 2017Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an... (Review)
Review
Patients with heart failure (HF) and their families experience stress and suffering from a variety of sources over the course of the HF experience. Palliative care is an interdisciplinary service and an overall approach to care that improves quality of life and alleviates suffering for those living with serious illness, regardless of prognosis. In this review, we synthesize the evidence from randomized clinical trials of palliative care interventions in HF. While the evidence base for palliative care in HF is promising, it is still in its infancy and requires additional high-quality, methodologically sound studies to clearly elucidate the role of palliative care for patients and families living with the burdens of HF. Yet, an increase in attention to primary palliative care (e.g., basic physical and emotional symptom management, advance care planning), provided by primary care and cardiology clinicians, may be a vehicle to address unmet palliative needs earlier and throughout the illness course.
Topics: Disease Progression; Family Health; Heart Failure; Humans; Palliative Care; Patient Care Team; Patient Comfort; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 28982506
DOI: 10.1016/j.jacc.2017.08.036 -
Nutrients Jan 2021The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a... (Review)
Review
The role of nutritional support for cancer patients in palliative care is still a controversial topic, in part because there is no consensus on the definition of a palliative care patient because of ambiguity in the common medical use of the adjective palliative. Nonetheless, guidelines recommend assessing nutritional deficiencies in all such patients because, regardless of whether they are still on anticancer treatments or not, malnutrition leads to low performance status, impaired quality of life (QoL), unplanned hospitalizations, and reduced survival. Because nutritional interventions tailored to individual needs may be beneficial, guidelines recommend that if oral food intake remains inadequate despite counseling and oral nutritional supplements, home enteral nutrition or, if this is not sufficient or feasible, home parenteral nutrition (supplemental or total) should be considered in suitable patients. The purpose of this narrative review is to identify in these cancer patients the area of overlapping between the two therapeutic approaches consisting of nutritional support and palliative care in light of the variables that determine its identification (guidelines, evidence, ethics, and law). However, nutritional support for cancer patients in palliative care may be more likely to contribute to improving their QoL when part of a comprehensive early palliative care approach.
Topics: Counseling; Humans; Malnutrition; Neoplasms; Nutrition Assessment; Nutritional Support; Palliative Care; Quality of Life
PubMed: 33498997
DOI: 10.3390/nu13020306 -
CA: a Cancer Journal For Clinicians Sep 2018Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer.... (Review)
Review
Over the past decade, a large body of evidence has accumulated supporting the integration of palliative care into oncology practice for patients with advanced cancer. The question is no longer whether palliative care should be offered, but what is the optimal model of delivery, when is the ideal time to refer, who is in greatest need of a referral, and how much palliative care should oncologists themselves be providing. These questions are particularly relevant given the scarcity of palliative care resources internationally. In this state-of-the-science review directed at the practicing cancer clinician, the authors first discuss the contemporary literature examining the impact of specialist palliative care on various health outcomes. Then, conceptual models are provided to support team-based, timely, and targeted palliative care. Team-based palliative care allows the interdisciplinary members to address comprehensively the multidimensional care needs of patients and their caregivers. Timely palliative care, at its best, is preventive care to minimize crises at the end of life. Targeted palliative care involves identifying the patients most likely to benefit from specialist palliative care interventions, akin to the concept of targeted cancer therapies. Finally, the strengths and weaknesses of innovative care models, such as outpatient clinics, embedded clinics, nurse-led palliative care, primary palliative care provided by oncology teams, and automatic referral, are summarized. Moving forward, more research is needed to determine how different health systems can best personalize palliative care to provide the right level of intervention, for the right patient, in the right setting, at the right time. CA Cancer J Clin. 2018;680:00-00. 2018 American Cancer Society, Inc.
Topics: Ambulatory Care; Caregivers; Delivery of Health Care; Evidence-Based Medicine; Humans; Neoplasms; Oncologists; Palliative Care; Patient Care Team; Physician's Role; Quality of Life; Referral and Consultation; Time-to-Treatment
PubMed: 30277572
DOI: 10.3322/caac.21490 -
Canadian Family Physician Medecin de... Apr 2019To help increase the confidence of both caregivers and clinicians in providing palliative care to adults with intellectual and developmental disabilities (IDD) using an... (Review)
Review
OBJECTIVE
To help increase the confidence of both caregivers and clinicians in providing palliative care to adults with intellectual and developmental disabilities (IDD) using an easy-to-follow framework to improve and overcome barriers to effective palliative care in this population.
QUALITY OF EVIDENCE
A literature review was conducted to explore recent best evidence to address these palliative care needs and to allow for a focused opportunity to consider the details of implementing clinical practice guidelines in the palliative care context. Evidence ranges from level I to level III.
MAIN MESSAGE
Pain and psychological and emotional distress are important issues for individuals with IDD, as they can be difficult to assess and measure, and often present atypically, especially in those with limited communication skills. Further, little is known about end-of-life needs in the adult population with IDD, especially for those living in community residences. The conducted literature review of patient, caregiver, and clinician experiences exposed considerable barriers, including incorrect assumptions about patients' capacity to understand and discomfort of both caregivers and clinicians with open communication. This has resulted in exclusion of adults with IDD from their own care, which has proven harmful. Maximizing time in familiar surroundings and establishing trust and continuity are crucial. Sometimes trial and error with empiric use of comfort medications is necessary, but this can be mitigated with careful examination of distress patterns and judicious use of diagnostic testing. It is always best to integrate the palliative approach into the existing pattern of care.
CONCLUSION
The validated tools and recommendations provided will assist with communication, symptom interpretation, treatment decisions, advanced care planning, addressing grief, and important considerations in end-of-life care.
Topics: Adult; Aged; Caregivers; Communication; Decision Making; Female; Health Services for Persons with Disabilities; Humans; Male; Middle Aged; Palliative Care; Persons with Mental Disabilities; Physician-Patient Relations
PubMed: 31023774
DOI: No ID Found -
Australian Journal of General Practice Nov 2018While most people say they would prefer to be cared for and to die at home, this outcome is often not achieved. This represents a service gap that general practitioners...
BACKGROUND
While most people say they would prefer to be cared for and to die at home, this outcome is often not achieved. This represents a service gap that general practitioners (GPs) are optimally positioned to fill.
OBJECTIVES
The aim of this paper is to synthesise existing evidence-based frameworks of palliative care together with other resources, to present a cohesive model of care that GPs can easily systematise to guide high-quality home-based palliative care.
DISCUSSION
Key clinical processes include advance care planning and development of medical goals of patient care plans and terminal care plans. Three essential elements for high-quality palliative care incorporated into the model include a compassionate GP, the care team and various practical resources. Palliative care sits well within the GP specialist scope of practice. GPs have at their disposal many resources that effectively and efficiently support them in their palliative care practice.
Topics: Advance Care Planning; Attitude of Health Personnel; General Practice; Home Care Services; Humans; Palliative Care
PubMed: 31207670
DOI: 10.31128/AJGP-06-18-4607 -
Journal of Health Psychology Mar 2019In palliative care, a biopsychosocial-spiritual model is essential to address the patient in totality. Spirituality is often a relevant issue in such settings, yet there...
In palliative care, a biopsychosocial-spiritual model is essential to address the patient in totality. Spirituality is often a relevant issue in such settings, yet there is a need to differentiate spirituality from religion. Spirituality in palliative care focuses on the psychological and spiritual aspects of care, helping to relieve the physical, emotional, social and spiritual distresses of the patient, family members and healthcare professionals, produced in such conditions. Psychologists, according to their ethical responsibilities, may include the assessment of their patients' spiritual needs in therapy, as it will help to identify the patients' values, belief systems, spiritual history, distress and needs. All patients have different needs, some may need religious/spiritual guidance, in collaboration with spiritual care workers, and others may not demonstrate needs regarding these issues. The essential is that each patient is treated as a 'whole', addressing his physical, psychological, social and spiritual needs.
Topics: Humans; Palliative Care; Spirituality
PubMed: 27531369
DOI: 10.1177/1359105316664138 -
Australian Journal of General Practice Nov 2018Palliative care aims to improve quality of life for patients with life-limiting illnesses. It is often linked to the care of people with cancer; however, patients with...
BACKGROUND
Palliative care aims to improve quality of life for patients with life-limiting illnesses. It is often linked to the care of people with cancer; however, patients with non-cancer end-stage conditions also have significant needs.
OBJECTIVES
The aims of this paper are to discuss common trajectories of deterioration in non-malignant conditions, consider possible barriers to palliative care referral, review the principles of the palliative care approach and illustrate specific factors relevant for common non-cancer conditions.
DISCUSSION
The symptom burden and care needs for patients with end-stage, nonmalignant illnesses are similar to those of patients with advanced cancer. These patients benefit from a palliative approach, comprising management of the underlying condition and attention to symptoms, psychosocial needs and carer support. Advance care planning provides an opportunity to prepare for future illness episodes, including provision of end-of-life care. General practitioners are well placed to provide palliative care for patients with advanced non-cancer illnesses.
Topics: Advance Care Planning; Heart Failure; Humans; Kidney Failure, Chronic; Nervous System Diseases; Palliative Care; Pulmonary Disease, Chronic Obstructive; Referral and Consultation
PubMed: 31207673
DOI: 10.31128/AJGP-07-18-4625 -
Journal of Medical Radiation Sciences Dec 2016Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of... (Meta-Analysis)
Meta-Analysis Review
Advanced cancer patients commonly have misunderstandings about the intentions of treatment and their overall prognosis. Several studies have shown that large numbers of patients receiving palliative radiation or chemotherapy hold unrealistic hopes of their cancer being cured by such therapies, which can affect their ability to make well-informed decisions about treatment options. This review aimed to explore this discrepancy between patients' and physicians' expectations by investigating three primary issues: (1) the factors associated with patients developing unrealistic expectations; (2) the implications of having unrealistic hopes and the effects of raising patients' awareness about prognosis; and (3) patients' and caregivers' perspective on disclosure and their preferences for communication styles. Relevant studies were identified by searching electronic databases including Pubmed, EMBASE and ScienceDirect using multiple combinations of keywords, which yielded a total of 65 articles meeting the inclusion criteria. The discrepancy between patients' and doctors' expectations was associated with many factors including doctors' reluctance to disclose terminal prognoses and patients' ability to understand or accept such information. The majority of patients and caregivers expressed a desire for detailed prognostic information; however, varied responses have been reported on the preferred style of conveying such information. Communication styles have profound effects on patients' experience and treatment choices. Patients' views on disclosure are influenced by many cultural, psychological and illness-related factors, therefore individuals' needs must be considered when conveying prognostic information. More research is needed to identify communication barriers and the interventions that could be used to increase patients' satisfaction with palliative care.
Topics: Humans; Neoplasms; Palliative Care; Physician-Patient Relations; Truth Disclosure
PubMed: 27741380
DOI: 10.1002/jmrs.188 -
BMC Palliative Care Aug 2019Recognising and knowing how to manage ethical issues and moral dilemmas can be considered an ethical skill. In this study, ethics of care is used as a theoretical...
BACKGROUND
Recognising and knowing how to manage ethical issues and moral dilemmas can be considered an ethical skill. In this study, ethics of care is used as a theoretical framework and as a regulatory criterion in the relationship among healthcare professionals, patients with palliative care needs and family members. This study is a part of a larger project aimed at developing and implementing a training programme on "ethical communication" addressed to professionals caring for patients with palliative care needs. The aim of this study was comprehending whether and how the ethics of care informs the way healthcare professionals make sense of and handle ethical issues in palliative care.
METHODS
Qualitative study employing a theoretically driven thematic analysis performed on semi-structured interviews. The research was conducted in a clinical cancer centre in northern Italy. Eligible participants were physicians and nurses from eleven hospital wards who assisted patients with chronic advanced disease daily and had previously attended a 4-h training on palliative care held by the hospital Palliative Care Unit.
RESULTS
The researchers identified five themes: morality is providing global care; morality is knowing how to have a relationship with patients; morality is recognizing moral principles; moral dimension and communication; and moral dilemmas are individual conflicts.
CONCLUSIONS
Ethics of care seems to emerge as a theoretical framework that includes the belief systems of healthcare professionals, especially those assisting patients with palliative care needs; moreover, it allows the values of both the patients and professionals to come to light through the relationship of care. Ethics of care is also appropriate as a framework for ethical training.
Topics: Adult; Aged; Ethics, Medical; Family; Female; Humans; Interviews as Topic; Italy; Male; Middle Aged; Moral Obligations; Palliative Care; Physicians; Qualitative Research
PubMed: 31399094
DOI: 10.1186/s12904-019-0453-2