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Palliative care and hospice

Floriana Caccamo, Simona Ghedin, Cristina Marogna
OBJECTIVES: Health workers, particularly those working in palliative care, are confronted daily with situations that increase stress and emotional fatigue, since constantly exposed to the disease and the death of patients. The proximity to the pain and the feelings of psychological suffering of patients submits them to a very intense emotional charge, making them susceptible to burnout. The skills required for those involved in this type of assistance are very specific and it is therefore necessary training that is aimed at providing the healthcare professional knowledge and basic skills, both professional and empathic, because the service is of good quality...
December 2017: Giornale Italiano di Medicina del Lavoro Ed Ergonomia
Ilaria Massa, Oriana Nanni, Flavia Foca, Marco Maltoni, Stefania Derni, Nicola Gentili, Giovanni Luca Frassineti, Andrea Casadei Gardini, Martina Valgiusti, Dino Amadori, Elena Prati, Mattia Altini, Davide Gallegati, Elisabetta Sansoni
BACKGROUND: Appropriate cessation of chemotherapy and timely referral of patients to hospice services are crucial for the quality of care near death. We investigated the quality of care in our Cancer Institute in very advanced metastatic colorectal cancer patients treated in real life. PATIENTS AND METHODS: We performed a retrospective analysis of electronic medical data of patients with metastatic colorectal cancer who were candidates for chemotherapy during the study period (1 January 2007-30 June 2014) and died before 31 December 2014...
June 19, 2018: BMC Palliative Care
Aparna Sai Ajjarapu, Ann Broderick
An estimated 1.5 billion people across the globe live with chronic pain, and an estimated 61 million people worldwide experience unrelieved serious health-related suffering. One-sixth of the global population lives in India, where approximately 10 million people endure unrelieved serious health-related suffering. The state of Kerala is home to Pallium India, one of the most sophisticated palliative care programs in the country. This private organization in Trivandrum provides palliative and hospice care to underresourced populations and emphasizes holistic pain treatment...
June 14, 2018: Permanente Journal
Katsiaryna Laryionava, Katja Mehlis, Elena Bierwirth, Friederike Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C Winkler
BACKGROUND: Many patients with advanced cancer receive chemotherapy close to death and are referred too late to palliative or hospice care, and therefore die under therapy or in intensive care units. Oncologists still have difficulties in involving patients appropriately in decisions about limiting tumor-specific or life-prolonging treatment. OBJECTIVE: The aim of this Ethics Policy for Advanced Care Planning and Limiting Treatment Study is to develop an ethical guideline for end-of-life decisions and to evaluate the impact of this guideline on clinical practice regarding the following target goals: reduction of decisional conflicts, improvement of documentation transparency and traceability, reduction of distress of the caregiver team, and better knowledge and consideration of patients' preferences...
June 15, 2018: JMIR Research Protocols
Kevin Madden, Minjeong Park, Diane Liu, Eduardo Bruera
BACKGROUND: Palliative care physicians often assist with pain management in children with cancer, but little is known about how they use long-acting opioids for chronic pain with these patients. OBJECTIVE: To determine the practices, attitudes, and beliefs of palliative care physicians toward the use of long-acting opioids in children with advanced cancer. DESIGN: An electronic survey was sent to all members of The American Academy of Pediatrics (AAP) Section of Hospice and Palliative Medicine (SOHPM) and those identified as physicians who provide palliative care to children on the AAP SOHPM LISTSERV® ...
June 12, 2018: Journal of Palliative Medicine
Rossana De Palma, Daniela Fortuna, Sarah E Hegarty, Daniel Z Louis, Rita Maria Melotti, Maria Luisa Moro
BACKGROUND: Multiple studies demonstrate substantial utilization of acute hospital care and, potentially excessive, intensive medical and surgical treatments at the end-of-life. AIM: To evaluate the relationship between the use of home and facility-based hospice palliative care for patients dying with cancer and service utilization at the end of life. DESIGN: Retrospective, population-level study using administrative databases. The effect of palliative care was analyzed between coarsened exact matched cohorts and evaluated through a conditional logistic regression model...
June 1, 2018: Palliative Medicine
B Flynn, M Barrett, J Sui, C Halpin, G Paz, D Walsh
BACKGROUND: Cancer cachexia is a multifactorial syndrome characterised by a progressive loss of skeletal muscle mass. It adversely influences quality of life, treatment response and survival. Early identification and multimodal interventions can potentially treat cancer cachexia. However, healthcare professionals demonstrate a lack of understanding and the ability to identify cancer cachexia early. The present study aimed to evaluate the assessment by physicians of nutritional status in cancer patients admitted to hospice...
June 7, 2018: Journal of Human Nutrition and Dietetics: the Official Journal of the British Dietetic Association
Jane Seymour, David Clark
Background : The Liverpool Care Pathway for the Dying Patient ('the LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review.  The ensuing debate among clinicians polarised between 'blaming' of the LCP and regret at its removal. Employing the concept of 'boundary objects', we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods : We use primary and secondary sources in the public domain to assemble a critical and historical review...
2018: Wellcome Open Research
Chiu-Hsuan Cheng, Borcherng Su, Dah-Ching Ding
OBJECTIVE: We describe the first case of a rare undifferentiated uterine sarcoma exhibiting both neuroectodermal differentiation and osteoclast-like giant cells, and elaborate its morphology. CASE REPORT: A 54-year-old woman presented with suprapubic pain, frequent urination, and perimenopausal abnormal vaginal bleeding. Computed tomography revealed a large heterogeneous uterine mass and multiple lung nodules. She received a staging surgery. The tumor pathology examination revealed an undifferentiated uterine sarcoma (UUS) with neuroectodermal differentiation and osteoclast-like giant cells (OGCs)...
June 2018: Taiwanese Journal of Obstetrics & Gynecology
Matthew J Allsop, Lucy E Ziegler, Matthew R Mulvey, Sarah Russell, Ros Taylor, Michael I Bennett
BACKGROUND: Understanding service provision for patients with advanced disease is a research priority, with a need to identify barriers that limit widespread integration of palliative care. AIM: To identify patient and organisational factors that influence the duration of hospice-based palliative care in the United Kingdom prior to death. DESIGN: This is a retrospective cohort study. SETTING/PARTICIPANTS: A total of 64 UK hospices providing specialist palliative care inpatient beds and community services extracted data for all adult decedents (aged over 17 years) with progressive, advanced disease, with a prior referral (e...
June 1, 2018: Palliative Medicine
Shunichi Nakagawa, Arthur R Garan, Hiroo Takayama, Koji Takeda, Veli K Topkara, Melana Yuzefpolskaya, Susan X Lin, Paolo C Colombo, Yoshifumi Naka, Craig D Blinderman
BACKGROUND: The difference of end-of-life care for left ventricular assist device (LVAD) patients, between destination therapy (DT) and bridge to transplant (BTT), and the effect of palliative care in this population remain unknown. OBJECTIVE: The primary outcomes of this retrospective cohort study were the place of death, do-not-resuscitate (DNR) order, palliative care consultation in the last month, and hospice enrollment. Secondary outcomes were time on the LVAD, life-sustaining treatment in the last week of life, LVAD deactivation, and clinical trajectory...
June 6, 2018: Journal of Palliative Medicine
David A Gruenewald
Some residents of long-term care (LTC) facilities with lethal or serious chronic illnesses may express a wish to hasten their death by voluntarily stopping eating and drinking (VSED). LTC facility clinicians, administrators, and staff must balance resident safety, moral objections to hastened death, and other concerns with resident rights to autonomy, self-determination, and bodily integrity. Initially, requests for hastened death, including VSED must be treated as opportunities to uncover underlying concerns...
June 5, 2018: Journal of Palliative Medicine
Amy Beasley, Marie A Bakitas, Rebecca Edwards, Dio Kavalieratos
Palliative care offers patients with a serious illness and their families access to services that can improve quality of life, mood, and symptoms. However, the term palliative care is often confused with end of life or hospice services limiting its application to persons with chronic illnesses who might benefit. Non-hospice palliative care is a term that is emerging to more accurately reflect the broader care model that palliative care represents. The aim of this review was to identify the characteristics of published nonhospice palliative care interventions...
April 25, 2018: Annals of Palliative Medicine
Elizabeth J Lilley, Katherine C Lee, John W Scott, Nicole J Krumrei, Adil H Haider, Ali Salim, Rajan Gupta, Zara Cooper
BACKGROUND: Palliative care is associated with lower intensity treatment and better outcomes at the end of life. Trauma surgeons play a critical role in end-of-life (EOL) care, however the impact of PC on healthcare utilization at the end of life has yet to be characterized in older trauma patients. METHODS: This retrospective cohort study using 2006-2011 national Medicare claims included trauma patients ≥65 years who died within 180 days after discharge. The exposure of interest was inpatient palliative care during the trauma admission...
May 30, 2018: Journal of Trauma and Acute Care Surgery
David Hausner, Nanor Kevork, Ashley Pope, Breffni Hannon, John Bryson, Jenny Lau, Gary Rodin, Lisa W Le, Camilla Zimmermann
PURPOSE: Acute palliative care units (APCUs) admit patients with cancer for symptom control, transition to community palliative care units or hospice (CPCU/H), or end-of-life care. Prognostication early in the course of admission is crucial for decision-making. We retrospectively evaluated factors associated with patients' discharge disposition on an APCU in a cancer center. METHODS: We evaluated demographic, administrative, and clinical data for all patients admitted to the APCU in 2015...
May 30, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Norinaga Urahama, Jun Sono, Kazumasa Yoshinaga
Most terminally ill cancer patients in our hospice ward are referred from hospitals for anticancer treatment. For identical terminally ill cancer patients referred from other hospitals, differences in the accuracy and characteristics of the prognostic prediction of survival by oncologists and palliative care physicians were examined. We investigated 101 patients and compared the prognostic value between the clinical prediction of survival with oncologists and prognostic tool-conducted prediction by palliative care physicians with the actual survival times; the results were then classified as accurate, pessimistic and optimistic...
May 30, 2018: Japanese Journal of Clinical Oncology
Thomas W LeBlanc, Pamela C Egan, Adam J Olszewski
Hospice provides high-quality end-of-life care, but patients with leukemias use hospice services less frequently than those with solid tumors. Transfusion dependence (TD) may hinder or delay enrollment, as hospice organizations typically disallow transfusions. We examined the association between TD and end-of-life outcomes among Medicare beneficiaries with leukemia. From the Surveillance, Epidemiology, and End Results-Medicare database, we selected beneficiaries with acute and chronic leukemias, who died in 2001-2011...
May 30, 2018: Blood
May Hua, Xiaoyue Ma, R Sean Morrison, Guohua Li, Hannah Wunsch
RATIONALE: In the intensive care unit (ICU), studies involving specialized palliative care services have shown decreases in the use of non-beneficial life-sustaining therapies and ICU length of stay for patients. However, whether widespread availability of hospital-based palliative care is associated with less frequent use of high intensity care is unknown. OBJECTIVE: To determine whether availability of hospital-based palliative care is associated with decreased markers of treatment intensity for ICU patients...
May 29, 2018: Annals of the American Thoracic Society
Aldis H Petriceks, John C Olivas, Sakti Srivastava
It is no secret that the average age of the U.S. population is increasing, and this has special significance for the U.S. health care system. The number of individuals above 65 years old is predicted to increase 55% by 2030, and all the while, there is a looming physician shortage, one especially relevant for Geriatricians. Therefore, current Geriatricians must have objective information to assess the past, present, and future state of this important specialty. However, little literature exists regarding the recent changes in Geriatrics-related graduate medical education programs...
January 2018: Gerontology & Geriatric Medicine
Burkhard Dasch, Claudia Bausewein, Berend Feddersen
BACKGROUND: Due to increasing life expectancy, more and more older people are suffering from dementia and comorbidities. To date, little information is available on place of death for dementia patients in Germany. In addition, the association of place of death and comorbidities is unknown. METHODS: A population-based cross-sectional survey was conducted in Westphalia-Lippe (Germany), based on the analysis of death certificates from 2011. Individuals with dementia ≥ 65 years were identified using the documented cause of death...
May 24, 2018: BMC Palliative Care
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