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care of patients at the end of life

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https://www.readbyqxmd.com/read/29667509/the-involvement-of-cancer-patients-in-the-four-stages-of-decision-making-preceding-continuous-sedation-until-death-a-qualitative-study
#1
Lenzo Robijn, Jane Seymour, Luc Deliens, Ida Korfage, Jayne Brown, Peter Pype, Agnes Van Der Heide, Kenneth Chambaere, Judith Rietjens
BACKGROUND: Involving patients in decision-making is considered to be particularly appropriate towards the end of life. Professional guidelines emphasize that the decision to initiate continuous sedation should be made in accordance with the wishes of the dying person and be preceded by their consent. AIM: To describe the decision-making process preceding continuous sedation until death with particular attention to the involvement of the person who is dying. DESIGN: Qualitative case studies using interviews...
April 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29667475/how-family-caregivers-help-older-relatives-navigate-statutory-services-at-the-end-of-life-a-descriptive-qualitative-study
#2
Lisa Ann Williams, Tess Moeke-Maxwell, Janine Wiles, Stella Black, Gabriella Trussardi, Ngaire Kerse, Merryn Gott
BACKGROUND: A key challenge in meeting the palliative care needs of people in advanced age is the multiple healthcare and social service agencies typically involved in their care. The 'patient navigator' model, originally developed in cancer care, is the professional solution most often recommended to address this challenge. However, little attention has been paid, or is known, about the role that family carers play in enabling their dying relatives to negotiate service gaps. AIM: To explore the role family caregivers play in helping people dying in advanced old age navigate health services at the end of life...
April 1, 2018: Palliative Medicine
https://www.readbyqxmd.com/read/29663697/testing-a-new-form-to-document-goals-of-care-discussions-regarding-plans-for-end-of-life-care-for-patients-in-an-australian-emergency-department
#3
Amber C Mills, Michele Levinson, William A Dunlop, Edward Cheong, Timothy Cowan, Jennifer Hanning, Erin O'Callaghan, Katherine J Walker
OBJECTIVE: There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. METHODS: This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences...
April 16, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29663015/-palliative-care-challenges-in-the-intensive-care-unit
#4
REVIEW
H Lemm, J Hoeger-Schäfer, M Buerke
Intensive care unit (ICU) stays often result due to an acute, potentially life-threatening illness or aggravation of a chronic life-threatening illness. In many cases, ICU patients die after life-sustaining treatments are withdrawn or withheld. When patients are asked, they prefer to die at home, although logistic and medical problems often prevent this. Therefore, attention focuses on care at the end of life in the ICU. Despite many efforts to improve the quality of care, evidence suggests that the quality in hospitals varies significantly and that palliative care in the ICU has not significantly improved over time...
April 16, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29661749/a-website-supporting-sensitive-religious-and-cultural-advance-care-planning-acptalk-formative-and-summative-evaluation
#5
Amanda Pereira-Salgado, Patrick Mader, Clare O'Callaghan, Leanne Boyd
BACKGROUND: Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations...
April 16, 2018: JMIR Research Protocols
https://www.readbyqxmd.com/read/29661335/head-and-neck-cancer-in-the-elderly-frailty-shared-decisions-and-avoidance-of-low-value-care
#6
REVIEW
Leila J Mady, Marci L Nilsen, Jonas T Johnson
Head and neck cancer (HNC) is a disease of older adults. Recurrent and metastatic head and neck squamous cell carcinoma portends a poor prognosis, with median overall survival of less than 12 months. Within this vulnerable population, significant treatment-related toxicities and physical and psychosocial sequelae can be devastating to quality of life at the end of life. Shared decision making and early comprehensive palliative and support services are at the crux of the approach to older adults with HNC. In doing so, low-value care that fails to meet the goals of patients and their caregivers at the end-of-life may be avoided...
May 2018: Clinics in Geriatric Medicine
https://www.readbyqxmd.com/read/29656713/symptom-management-nutrition-and-hydration-at-end-of-life-a-qualitative-exploration-of-patients-carers-and-health-professionals-experiences-and-further-research-questions
#7
Jessica Baillie, Despina Anagnostou, Stephanie Sivell, Jordan Van Godwin, Anthony Byrne, Annmarie Nelson
BACKGROUND: Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients' symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives' distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives...
April 16, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29656565/rural-urban-differences-in-costs-of-end-of-life-care-for-the-last-6-months-of-life-among-patients-with-breast-lung-or-colorectal-cancer
#8
Elizabeth Crouch, Jan M Eberth, Janice C Probst, Kevin Bennett, Swann A Adams
PURPOSE: The purpose of this study was to examine rural-urban differences in utilization and expenditures in the last 6 months of life for patients with breast, lung, or colorectal cancer. METHODS: The study used a 5% sample of the 2013 Medicare Research Identifiable Files to study utilization and expenditures for beneficiaries with breast, lung, or colorectal cancer during the last 6 months before death (n = 6,214). End of life expenditures were calculated as the sum of total Medicare expenditures for inpatient, outpatient, physician, home health, hospice, and skilled nursing facility costs during the last 6 months of life...
April 15, 2018: Journal of Rural Health
https://www.readbyqxmd.com/read/29652733/circumstances-and-signs-of-approaching-death-in-patients-with-amyotrophic-lateral-sclerosis-undergoing-noninvasive-ventilation-in-home-care-settings
#9
Mitsuko Ushikubo
The purpose of this study was to elucidate the circumstances and symptoms of patients with amyotrophic lateral sclerosis (ALS) using noninvasive positive pressure ventilation (NPPV) in whom death was approaching, to understand how to provide palliative care to dying patients with ALS receiving NPPV management. The participants were 6 home visiting nurses who were head or subhead nurses of a home visiting nursing agency. Data were collected data conducting individual semistructured interviews and then group interviews...
April 12, 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/29650880/-team-collaboration-in-home-medical-care-to-support-patients-at-the-end-of-life-review-of-service-personnel-meeting-on-discharge-day
#10
Miyoko Ogiwara, Hiromi Irino, Keita Yamaoka, Yoko Fujimaki, Mutsuko Watanabe, Takeshi Yamamoto, Masayoshi Hirohara, Kazuki Kushida
Due to the rising number of patients at the terminal stage or with high dependence on medical care, the cooperation of 2 teams, the hospital discharge support team and the home support team, has become very important. The recent spread of the Internet has enabled both patients and their families who have chosen home care to obtain a wide range of information about home services, as well as diseases, and form a picture of what will happen. However, there are actually many cases in which patients and families find that things are not as they imagined, and they are uneasy and unsure of what to do...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29650872/-examination-of-patients-that-died-within-48-hours-after-urgent-hospitalization
#11
Kazuhiro Kawada, Ryota Yanaizumi, Osamu Takahashi
We offer inpatient support for end-stage cancer patients, not only in palliative care units, but also in general medical and long-term care units. We also provide outpatient palliative care and offer emergent backup for the regional home care clinics. From January 2014 to December 2016, 1,832 patients were hospitalized, and among them, 983 patients visited our hospital on an emergency basis. Among the urgent hospitalized patients, 378 patients returned home after adequate palliative care. But 605 patients had to stay admitted in the hospital until their time of death...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29650861/-the-influence-of-the-timing-of-ceasing-or-withholding-chemotherapy-in-home-based-end-of-life-care-in-patients-with-incurable-solid-cancer-release-of-an-interim-report-of-the-questionnaire-survey-to-home-care-doctors-in-japan
#12
Toshikazu Sakuyama, Yoshikazu Asino, Masahito Tanimizu, Fumio Ogasawara, Akitaka Yoshizawa, Hiroshi Suzuki, Kunihiko Watanabe, Manabu Ohnuki, Mitsunori Nishikawa, Akemi Katami, Noriyasu Shirotani
BACKGROUND: The study analyzes a questionnaire on the potential discriminative characteristics of patients with incurable solidcancer, who either receivedor didnot receive palliative chemotherapy while receiving home-basedend -of-life care. From the standpoint of regional palliative care, we sought to investigate the influence of the timing of when chemotherapy was ceasedor withheldin home-basedend -of-life care in patients with incurable solidcancer. We plannedthe project to obtain scientific evidence about the timing of ceasing or withholding chemotherapy...
March 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/29650621/barriers-to-and-enablers-of-advance-care-planning-with-patients-in-primary-care-survey-of-health-care-providers
#13
Michelle Howard, Carrie Bernard, Doug Klein, Dawn Elston, Amy Tan, Marissa Slaven, Doris Barwich, John J You, Daren K Heyland
OBJECTIVE: To identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care. DESIGN: Cross-sectional, self-administered survey. SETTING: Ontario, Alberta, and British Columbia. PARTICIPANTS: Family physicians (n = 117) and other health professionals (n = 64) in primary care. MAIN OUTCOME MEASURES: Perceived barriers relating to the clinician, characteristics of patients, and system factors, rated on a 7-point scale from 0 (not at all) to 6 (an extreme amount), and enablers reported using an open-ended question...
April 2018: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/29649845/-early-palliative-care-in-emergency-medicine
#14
Maximilian Spickermann, Philipp Lenz
At the end of life patients with a life-limiting disease are often admitted to emergency departments (ED). Mostly, in the setting of an ED there may not be enough time to meet the needs for palliative care (PC) of these patients. Therefore, integration of PC into the ED offers a solution to improve their treatment. In the outpatient setting a cooperation between prehospital emergency services, the patient's general practitioner and specialized outpatient PC teams may allow the patient to die at home - this is what most patients prefer at the end of life...
April 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29649403/the-arianna-project-an-observational-study-on-a-model-of-early-identification-of-patients-with-palliative-care-needs-through-the-integration-between-primary-care-and-italian-home-palliative-care-units
#15
Gianlorenzo Scaccabarozzi, Emanuele Amodio, Giacomo Pellegrini, Fabrizio Limonta, Pierangelo Lora Aprile, Pietro Giorgio Lovaglio, Carlo Peruselli, Matteo Crippa
OBJECTIVE: The aim of this study was to illustrate the characteristics of patients with palliative care (PC) needs, early identified by general practitioners (GPs), and to analyze their care process in home PC services. BACKGROUND: Early identification and service integration are key components to providing quality palliative care (PC) services ensuring the best possible service for patients and their families. However, in Italy, PC is often provided only in the last phase of life and for oncological patients, with a fragmented service...
March 20, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649402/end-of-life-treatments-in-pediatric-patients-at-a-government-tertiary-cancer-center-in-india
#16
Jean Jacob, Jaskirt K Matharu, Gayatri Palat, Sudha Sinha, Eva Brun, Thomas Wiebe, Mikael Segerlantz
AIM: The primary objective of this study was to describe demographics and end-of-life treatments of children with cancer at a government tertiary cancer center in India. METHODS: A retrospective review was undertaken of medical charts of all children younger than 18 years, who died as inpatients while undergoing treatment at the pediatric oncology department between April and September 2016. Data were collected on demographics, diagnosis, treatments, survival, palliative care involvement, and symptoms at end of life...
March 20, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649400/impact-of-inpatient-palliative-care-on-quality-of-end-of-life-care-and-downstream-acute-and-postacute-care-utilization
#17
Peter S Khang, Susan E Wang, In-Lu Amy Liu, Heather L Watson, Sandra Y Koyama, Dan N Huynh, Janet S Lee, Huong Q Nguyen
BACKGROUND: Additional evidence is needed regarding the impact of inpatient palliative care (IPC) on the quality of end-of-life care and downstream utilization. AIM: Examine the effects of IPC on quality of end-of-life care and acute and postacute care use in a large integrated system. DESIGN: Retrospective cohort design. SETTING/PARTICIPANTS: Adult decedents from January 1, 2012, to December 31, 2014, who had at least one hospitalization at 11 Kaiser Permanente Southern California medical centers in the 12 months before death and not hospitalized for a trauma-related condition or receiving home-based PC or hospice were included in the cohort...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649399/a-rules-based-algorithm-to-prioritize-poor-prognosis-cancer-patients-in-need-of-advance-care-planning
#18
Christine M Bestvina, Kristen E Wroblewski, Bobby Daly, Brittany Beach, Selina Chow, Andrew Hantel, Monica Malec, Michael T Huber, Blase N Polite
BACKGROUND: Accurate understanding of the prognosis of an advanced cancer patient can lead to decreased aggressive care at the end of life and earlier hospice enrollment. OBJECTIVE: Our goal was to determine the association between high-risk clinical events identified by a simple, rules-based algorithm and decreased overall survival, to target poor prognosis cancer patients who would urgently benefit from advanced care planning. DESIGN: A retrospective analysis was performed on outpatient oncology patients with an index visit from April 1, 2015, through June 30, 2015...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649396/surgeons-perceived-barriers-to-palliative-and-end-of-life-care-a-mixed-methods-study-of-a-surgical-society
#19
Pasithorn A Suwanabol, Ari C Reichstein, Z Tuba Suzer-Gurtekin, Jane Forman, Maria J Silveira, Lona Mody, Arden M Morris
BACKGROUND: Nearly 20% of colorectal cancer (CRC) patients present with potentially incurable (Stage IV) disease, yet their physicians do not integrate cancer treatment with palliative care. Compared with patients treated by primary providers, surgical patients with terminal diseases are significantly less likely to receive palliative or end-of-life care. OBJECTIVE: To describe surgeon perspectives on palliative and end-of-life care for patients with Stage IV CRCs...
March 13, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29649394/perspective-on-care-at-the-end-of-life-at-hospice-africa-uganda
#20
Joshua Campbell, Nasur Buyinza, Joshua Hauser
BACKGROUND: Since its beginning in 1993, Hospice Africa Uganda (HAU) has become a leader in palliative care in Africa. Despite this, there remains a sparsity of research elucidating the priorities of patients in their care at the end of life. This study aimed to identify those priorities in three groups: patients with life-limiting illness, their caregivers, and their healthcare providers at HAU, and thus to identify differences in what these groups find important in the last month of life...
March 13, 2018: Journal of Palliative Medicine
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