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End of life, palliative care, terminal, comfort care

Jean François Ciais, Flora Tremellat, Maud Castelli-Prieto, Caroline Jestin
BACKGROUND: At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. OBJECTIVE: The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life...
September 27, 2016: Journal of Palliative Medicine
Kay De Vries, Marek Plaskota
OBJECTIVE: Palliative sedation is a method of symptom management frequently used in hospices to treat uncontrolled symptoms at the end of life. There is a substantial body of literature on this subject; however, there has been little research into the experiences of hospice nurses when administering palliative sedation in an attempt to manage the terminal restlessness experienced by cancer patients. METHOD: Semistructured interviews were conducted with a purposive sample of seven hospice nurses who had cared for at least one patient who had undergone palliative sedation within the past year in a hospice in the south of England in the United Kingdom...
June 21, 2016: Palliative & Supportive Care
Anniek D Masman, Monique van Dijk, Joost van Rosmalen, Heleen J Blussé van Oud-Alblas, Erwin Ista, Frans P M Baar, Dick Tibboel
CONTEXT: If regular therapies cannot relieve symptoms sufficiently in the last days of life, continuous palliative sedation may serve to reduce consciousness. Sedation level can be measured with EEG monitoring with the bispectral index (BIS) monitor. OBJECTIVES: To determine the feasibility and validity of BIS monitoring in terminally ill patients. METHODS: In this prospective study, BIS registrations were performed in unconscious end-of-life patients admitted to a palliative care center...
August 2016: Journal of Pain and Symptom Management
Caroline Drolet, Helene Roy, Julie Laflamme, Marie-Eve Marcotte
BACKGROUND: The oral transmucosal (OTM) route for administration of comfort medication in infants at the end-of-life has long been favored by our pediatric palliative care team but has rarely been described in the literature. OBJECTIVE: To determine the feasibility of implementing a standardized comfort care protocol using OTM medications in dying neonates. METHOD: A comfort protocol prescribing medication by the OTM route and standardized assessment were established...
April 2016: Journal of Palliative Medicine
Deborah Morris, Marissa Galicia-Castillo
BACKGROUND: While many patients hope to die at home, many die in hospitals. Patients die with unrecognized and untreated symptoms including dyspnea. OBJECTIVE: We sought to determine prevalence of dyspnea at end of life in patients dying in acute hospital care and examine treatment patterns. DESIGN/PARTICIPANTS: A retrospective chart review of deaths at tertiary care hospital over a 3-month period evaluated dyspnea in last 24 hours of life, opioid orders and administration as well as presence of palliative care consultation...
September 3, 2015: American Journal of Hospice & Palliative Care
Mayra Delalibera, Joana Presa, António Barbosa, Isabel Leal
Caring for a family member with an advanced and/or terminal illness can be a great emotional, physical and financial burden that has an impact on the quality of life of the caregivers. The scope of this study was to conduct a systematic review of the literature on the burden of caregiving, related factors and the consequences for family caregivers of advanced stage cancer patients or patients in end-of-life or palliative care. A search for scientific papers published in the EBSCO, Web of Knowledge and BIREME databases was conducted since records on this topic began in the databases through March 2014...
September 2015: Ciência & Saúde Coletiva
A B Piedrafita-Susín, E Yoldi-Arzoz, M Sánchez-Fernández, E Zuazua-Ros, M Vázquez-Calatayud
BACKGROUND: Adequate provision of palliative care by nursing in intensive care units is essential to facilitate a "good death" to critically ill patients. OBJECTIVE: To determine the perceptions, experiences and knowledge of intensive care nurses in caring for terminal patients. METHODOLOGY: A literature review was conducted on the bases of Pubmed, Cinahl and PsicINFO data using as search terms: cuidados paliativos, UCI, percepciones, experiencias, conocimientos y enfermería and their alternatives in English (palliative care, ICU, perceptions, experiences, knowledge and nursing), and combined with AND and OR Boolean...
October 2015: Enfermería Intensiva
Rachel Duarte Moritz, Fernando Osni Machado, Maike Heerdt, Bruna Rosso, Guilherme Beduschi
OBJECTIVES: To evaluate the medical decisions at end-of-life of patients admitted at HU/UFSC and to compare these decisions and the profile of patients who died in the intensive care unit (ICU) to those who died in medical (MW) and surgical wards (SW). METHODS: This is a retrospective and observational study. Demographic data, clinical features, treatment and the end-of-life care decisions of adult patients who died in wards and the intensive care unit of HU/UFSC from July/2004 to December/2008 were analyzed ...
June 2009: Revista Brasileira de Terapia Intensiva
Myung Kyung Lee, Woo Jin Lee, Young Rok Do, Keun Seok Lee, Kyung Hae Jung, Dae Seog Heo, Sam Yong Kim, Sang Yoon Park, Hyun Sik Jeong, Jung Hun Kang, Si-Young Kim, Sook Ryun Park, Young Ho Yun
OBJECTIVE: This study examined changes in health-related quality of life (HRQoL) and quality of care (QoC) as perceived by terminally ill cancer patients and a stratified set of HRQoL or QoC factors that are most likely to influence survival at the end of life (EoL). METHOD: We administered questionnaires to 619 consecutive patients immediately after they were diagnosed with terminal cancer by physicians at 11 university hospitals and at the National Cancer Center in Korea...
August 2015: Palliative & Supportive Care
Rebecca Colman, Lianne G Singer, Reeta Barua, James Downar
BACKGROUND: Lung transplantation (LT) recipients carry a high symptom burden. Palliative Care (PC) is a field of medicine focused on symptom control and psychosocial support, but transplant recipients are often referred to PC very late in the disease course, if at all. In our institution, the LT service has increasingly consulted PC to co-manage LT recipients with end-stage graft dysfunction or other terminal conditions. We present the characteristics, PC interventions used, and outcomes of these patients...
March 2015: Journal of Palliative Medicine
Hunter Groninger, Jayne M Phillips
A distressing complication for patients and families, gross hematuria at the end of life challenges hospice and palliative care clinicians to utilize skills in medical and nursing management, communication and clarification of patient goals, and relief of symptom burden. Massive hemorrhage in the genitourinary tract can radically alter the terminal trajectory for patients and necessitate intensive interventions aimed at promoting comfort. Here, a case of gross hematuria in an adult hospice patient serves to broaching decision-making challenges and management strategies...
May 12, 2012: Journal of Hospice and Palliative Nursing: JHPN
Manuel Martínez-Sellés, María Teresa Vidán, Ramón López-Palop, Lourdes Rexach, Elisabet Sánchez, Tomás Datino, María Cornide, Pilar Carrillo, José M Ribera, Oscar Díaz-Castro, Camino Bañuelos
This document was produced by the Spanish Society of Cardiology Section on Geriatric Cardiology "Endstage heart disease in the elderly" working group. Its aim was to provide an expert overview that would increase understanding of the last days of life of elderly patients with heart disease and improve treatment and clinical decision-making. As elderly heart disease patients form a heterogeneous group, thorough clinical evaluation is essential, in particular to identify factors that could influence prognosis (eg, heart disease, comorbid conditions, functional status, and frailty)...
April 2009: Revista Española de Cardiología
Edith Ubogagu, Dylan G Harris
OBJECTIVE: Terminal haemorrhage is a rare and distressing emergency in palliative oncology. We present an algorithm for the management of terminal haemorrhage in patients likely to receive end-of-life care at home, based on a literature review of the management of terminal haemorrhage for patients with advanced cancer, where a DNAR (do not attempt resuscitation) order is in place and the patient wishes to die at home. METHOD: A literature review was conducted to identify literature on the management of terminal haemorrhage in patients with advanced cancer who are no longer amenable to active interventional/invasive procedures...
December 2012: BMJ Supportive & Palliative Care
M Kishino, M Miyashita
Self-perceived burden (SPB) is a common problem in terminally ill cancer patients. SPB affects decision making such as life-sustaining treatments, choosing care facilities and communication between patients and the family at the end of life. However there are few studies clarifying SPB. The purpose of this study were to describe the experience of SPB in terminally ill cancer patients at palliative care unit in Japan, and to obtain what patients need medical staff to do to relieve SPB. Semi-structured interviews were conducted in five patients...
June 2011: BMJ Supportive & Palliative Care
Cynthia Hsu-Kim, Tara Friedman, Edward Gracely, James Gasperino
BACKGROUND: Many terminally ill patients experience an increasing intensity of medical care, an escalation frequently not consistent with their preferences. In 2009, formal palliative care consultation (PCC) was integrated into our medical intensive care unit (ICU). We hypothesized that significant differences in clinical and economic outcomes exist between ICU patients who received PCC and those who did not. METHODS: We reviewed ICU admissions between July and October 2010, identified 41 patients who received PCC, and randomly selected 80 patients who did not...
September 2015: Journal of Intensive Care Medicine
Zachary O Binney, Tammie E Quest, Paul L Feingold, Timothy Buchman, Alyssa A Majesko
OBJECTIVES: End-of-life care is frequently provided in the ICU because patients receiving life-sustaining treatments are often unsuitable for transfer to home or community hospices. In-hospital dedicated hospice inpatient units are a novel option. This study was designed to 1) demonstrate the feasibility of ICU to dedicated hospice inpatient unit transfer in critically ill terminal patients; 2) describe the clinical characteristics of those transferred and compare them to similar patients who were not transferred; and 3) assess the operational and economic impact of dedicated hospice inpatient units...
May 2014: Critical Care Medicine
Marta Sierra García, María Getino Canseco
This article is a descriptive literature review on the topic of spirituality, in a palliative care aimed at adult patients with different pathologies that are in an advanced stage of the disease. We analyze the sociocultural construction of spirituality at the end of life in the domiciliary environment, relating it to the disease process, its terminality and death. We describe the attention of the palliative-nurses, caring for the spiritual needs from a holistic point of view. It has to be considered that if the palliative-nurses are aware of the spirituality of patients with terminal illness should have some established strategies in their efforts to provide spiritual comfort...
September 2013: Revista de Enfermería
Mary Ann Meeker, Deborah P Waldrop, Jaclyn Schneider, Amy A Case
CONTEXT: Despite improvements in end-of-life care, some unrelieved suffering persists for patients with advanced illness and their family members. Hospice and palliative care services can reduce suffering, but these services remain under-used. OBJECTIVES: To investigate how patients with advanced illness and their primary caregivers experienced and responded to health care needs and decision making and how some dyads moved toward comfort-focused care. METHODS: This was a qualitative study using the grounded theory method for sample selection, data collection, and analysis...
May 2014: Journal of Pain and Symptom Management
Ceci Figueredo da Silva, Dalila Melo Souza, Larissa Chaves Pedreira, Manuela Ribeiro dos Santos, Tássia Nery Faustino
The scope of this paper was to analyze the perceptions of the multi-professional team on the implementation of palliative care in an adult intensive care unit. An exploratory-descriptive study using a qualitative approach was conducted with 14 health professionals from a public teaching hospital. The information was collected between February and April 2012, by means of semi-structured interviews and non-participatory observation interpreted using content analysis. Three thematic categories were identified: Care for terminal patients in an ICU fostering physical comfort; Lack of preparation of the team in dealing with terminal patients; and Challenges of palliative care practices in the intensive care environment...
September 2013: Ciência & Saúde Coletiva
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