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Hospice and palliative care

Maria Jose Armendariz Dyer
Ecuador, located in South America, has a population of 16 million people. According to the National Institution of Statistics in Ecuador, every year 8 out of a 1000 individuals die due to various causes. Palliative care and hospice are relatively new concepts for the Ecuadorian society. In Ecuador people usually die at home, in hospitals, or in nursing homes. In 2012, the first Ecuadorian hospice was created. According to symbolic interactionism theory, research needs to study participants' world in order to understand the dynamic nature of human behavior...
November 14, 2018: Omega
Choo Hwee Poi, Hwee Sing Khoo, Yong Hwang M Koh, Allyn Hum Yin Mei
OBJECTIVES: Junior doctors learn from the formal and informal curriculum. In a palliative care rotation, the informal curriculum may be useful in teaching attitudes like empathy and compassion. Our study aims to explore how the informal curriculum augments the formal curriculum of a palliative care rotation in shaping the professional development of a doctor. METHODS: We conducted a qualitative study with seven focus group discussions involving 21 junior doctors (medical officers and residents) who spent at least 2 months in a palliative care setting in a tertiary hospital or an inpatient hospice...
November 12, 2018: BMJ Supportive & Palliative Care
Szilvia Vas, Rachel Povey, David Clark-Carter
BACKGROUND: Illness adjustment is a widely studied area in the palliative care context. However, research focussing on how altered body image can affect men and women in palliative care is limited and unclear. AIM: To explore the links between palliative care patients' affected sense of self, altered body image and terminal illness adjustment. DESIGN: Semi-structured interviews were conducted, and the Interpretative Phenomenological Analysis approach was used to analyse patients' experiences...
November 12, 2018: Palliative Medicine
Marin Golčić, Renata Dobrila-Dintinjana, Goran Golčić, Lidija Gović-Golčić
Introduction: Opioids are the most important drugs in treating pain in palliative care patients. Transdermal formulations are especially useful due to their noninvasive nature and minimal interference in daily life. However, studies have shown a controversial relationship of opioids to survival and a rise in deaths associated with the use of transdermal opioids. Although applying precise doses is paramount, we have no clear recommendations for the exact equianalgesic ratio for buprenorphine patch and no recommendation for the type of transdermal opioid to use in hospice...
2018: Pain Research and Treatment
Ian Koper, H Roeline W Pasman, Bregje D Onwuteaka-Philipsen
BACKGROUND: Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. METHODS: Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding...
November 8, 2018: BMC Health Services Research
Mathilde Adsersen, Lau Caspar Thygesen, Mette Asbjoern Neergaard, Anders Bonde Jensen, Per Sjøgren, Anette Damkier, Lars Michael Clausen, Mogens Groenvold
BACKGROUND: The utilization of the health care system varies in relation to cohabitation status, but conflicting results have been found in studies investigating the association in relation to specialized palliative care (SPC). OBJECTIVE: To investigate the association between cohabitation status and admittance to SPC; to establish whether this association differed between hospital-based palliative care team/units (mainly outpatient/home care) and hospice (mainly inpatient care)...
November 7, 2018: Journal of Palliative Medicine
Robert Gramling, Elizabeth Gajary-Coots, Jenica Cimino, Kevin Fiscella, Ronald Epstein, Susan Ladwig, Wendy Anderson, Stewart C Alexander, Paul K Han, David Gramling, Sally A Norton
CONTEXT: Clinicians frequently overestimate survival time in serious illness. OBJECTIVE: To understand the frequency of overestimation in palliative care (PC) and the relation with end-of-life (EOL) treatment. METHODS: This is a multi-site cohort study of 230 hospitalized patients with advanced cancer who consulted with PC between 2013 and 2016. We asked the consulting PC clinician to make their "best guess" about the patients' "most likely survival time, assuming that their illnesses are allowed to take their natural course...
October 31, 2018: Journal of Pain and Symptom Management
Erica C Kaye, Melanie Gattas, Ashley Kiefer, Jason Reynolds, Kristina Zalud, Chen Li, Zhaohua Lu, Justin N Baker
CONTEXT: Approximately 500,000 children in the United States suffer from life-limiting illnesses each year, many of whom are hospice eligible each year. Few hospice agencies, however, offer formal pediatric programs. OBJECTIVE: To determine the levels of experience and comfort of hospice nurses who provide care to children and families in the community. METHODS: A cross-sectional survey was developed to assess hospice nurse experience/comfort across the domains of symptom management, end-of-life care, goals of care, family-centered care, and bereavement...
October 31, 2018: Journal of Pain and Symptom Management
Devin Miller, Nicole Nevadunsky
The purpose of this article is to review data supporting the benefit of palliative care, specifically for women with advanced ovarian cancer. Authors discuss barriers to implementation of palliative care, including confusion with hospice and challenges of prognostication. Generalist-level palliative techniques for treatment of pain, shortness of breath, bowel obstruction, and ascites are described. A description of physician-assisted suicide in legalized states is provided. Resources for physicians regarding communication and end-of-life decision making support for patients and their families...
December 2018: Hematology/oncology Clinics of North America
María Teresa García-Baquero Merino
Our medicalised modern cultures render reason and mystery mutually exclusive, define death by disease as failure, and dying as disgraceful. Providers and policymakers alike marginalize aging and dying individuals, formulating largely ineffective strategies without palliative care and pain relief budgets. The aim of palliative care is to support the person with incurable illness to live their remaining life as well and as meaningfully as possible and to support them as they eventually die from their illness and reaching the natural end of their lives It acknowledges that each life is morally significant, restoring patients' and families' quality of life where possible, and attending meticulously to the dying period as necessary (Saunders, 1965)...
2018: Frontiers in Pharmacology
Gursharan K Singh, Patricia M Davidson, Peter S Macdonald, Phillip J Newton
BACKGROUND: Chronic heart failure is a complex and multifaceted syndrome characterised by an unpredictable trajectory, high symptom burden and reduced quality of life. Although palliative care is recommended, patient, provider and system factors limit access. AIM: To examine the knowledge, attitudes and perspectives of health care professionals towards end of life care and palliative care for patients with chronic heart failure. DESIGN: This is an integrative review...
October 17, 2018: Heart, Lung & Circulation
Haiyan Xie, Elizabeth Johnston Taylor, Mengqi Li, Ying Wang, Tao Liang
AIMS AND OBJECTIVES: The aim of this study was to translate and validate the Nurse Spiritual Therapeutics Scale (NSTS) among cancer patients in Beijing, China. BACKGROUND: Spirituality is an essential and integrating facet of persons. However, spirituality is a new concept for most people in mainland China. METHODS: The NSTS was translated, adapted, and content-validated. The psychometric evaluation was performed with data collected from cancer patients hospitalized in one of two academic medical centers...
October 30, 2018: Journal of Clinical Nursing
Jong-Yi Wang, Hui-Lin Zhuang, Jeng-Yuan Chiou, Chia-Woei Wang, Chen-Yu Wang, Li-Fan Liu
BACKGROUND: Certified nursing assistants (CNAs) in palliative care units often encounter the death of patients and undergo emotional burdens because of their altruistic practices. However, the influences of altruism and perceptions of death on the work morale of CNAs remain unclear. The fact that morale can be improved by modifying related factors justifies the necessity of a theoretical model of morale for CNAs. However, such a model is currently absent. Based on relevant literature, factors including altruism, social support, perceptions of death, and job satisfaction are related to morale through the mediation of job stress...
2018: PloS One
Corbin Pagano, Ana Cios, Stefan David
Cutaneous angiosarcoma (CA) is a rare form of cancer with limited treatment options and has a very severe prognosis. In this case report, a differential diagnosis, ranging from infection and neoplasia to autoimmune disease, was attributed to recurrent cellulitis centered on a purple lesion. The continuous pursuit of a diagnosis and treatment plan had to be tailored in accordance with patient goals of care. Careful anticipation of disease progression and complications was required following the diagnosis of CA and involved careful transition from palliation to hospice care...
2018: Journal of Community Hospital Internal Medicine Perspectives
J Livergant, M Howard, J Klein
AIMS: Palliative radiotherapy (PRT) can relieve symptoms and improve quality of life, but remains underutilised, possibly due to lack of referrals. We conducted a systematic review to study barriers impeding referral for PRT. MATERIALS AND METHODS: We searched EMBASE and MEDLINE to identify published studies of physician barriers to PRT referral. Data were synthesised using the percentage of respondents to the surveys in these studies who identified a given factor as a significant barrier to PRT referral...
October 20, 2018: Clinical Oncology: a Journal of the Royal College of Radiologists
Karen Harrison Dening, Jaqueline Crowther, Sadaf Adnan
Addressing palliative care needs of people with dementia appropriately, identifying the end-of-life stage, meeting the needs of family carers as well as supporting the preferences and wishes of the person with the diagnosis can all present challenges to generalist health and social care providers. In partnership with Dementia UK and Kirkwood Hospice in West Yorkshire embarked upon a two-year pilot to introduce the first end-of-life care Admiral Nurse to their Specialist Community Palliative Care Team to identify and support people with dementia who required palliative and end-of-life care...
October 22, 2018: Dementia
Laura C Hanson, Christine E Kistler, Kyle Lavin, Stacey L Gabriel, Natalie C Ernecoff, Feng-Chang Lin, Greg A Sachs, Susan L Mitchell
CONTEXT: Persons with late-stage dementia have limited access to palliative care. OBJECTIVE: To test dementia-specific specialty palliative care triggered by hospitalization. METHODS: This pilot randomized controlled trial enrolled 62 dyads of persons with late-stage dementia and family decision-makers on admission to hospital. Intervention dyads received dementia-specific specialty palliative care consultation plus post-acute transitional care...
October 17, 2018: Journal of Pain and Symptom Management
Karina Deckert, Julia Walter, Larissa Schwarzkopf
BACKGROUND: When patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs...
October 19, 2018: BMC Health Services Research
Cathryn Pinto, Katherine Bristowe, Jana Witt, Joanna M Davies, Susanne de Wolf-Linder, Marsha Dawkins, Ping Guo, Irene J Higginson, Barbara Daveson, Fliss E M Murtagh
BACKGROUND: Routine use of outcome measures in palliative care is recommended to demonstrate and improve quality of care. The use of outcome measures is relatively recent in UK specialist palliative care services and understanding their use in practice is key to successful implementation. We therefore aimed to explore how patient-centred outcome measures are used in specialist palliative care, and identify key considerations for implementation. METHODS: Multi-method qualitative study (semi-structured interviews and non-participant observation)...
October 2018: Annals of Palliative Medicine
Sebastiano Mercadante, Francesco Masedu, Marco Maltoni, Daniela De Giovanni, Luigi Montanari, Cristina Pittureri, Raffaella Bertè, Domenico Russo, Laura Ursini, Franco Marinangeli, Federica Aielli
The aim of this study is to investigate the relationship between delirium and symptom expression in advanced cancer patients admitted to palliative care services. This is a secondary analysis of a consecutive sample of advanced cancer patients who were admitted to home care and hospices, and prospectively assessed for a period of 10 months. The Edmonton Symptom Assessment Scale (ESAS) and the MDAS (Memorial Delirium Assessment Scale) were measured at admission (T0) and after seven days of home care or hospice care (T7)...
October 17, 2018: Internal and Emergency Medicine
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