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Early intervention of palliative care

Kathleen Oare Lindell, Mehdi Nouraie, Melinda J Klesen, Sara Klein, Kevin F Gibson, Daniel J Kass, Margaret Quinn Rosenzweig
Introduction: Idiopathic pulmonary fibrosis (IPF), a progressive life-limiting lung disease affects approximately 128 000 newly diagnosed individuals in the USA annually. IPF, a disease of ageing associated with intense medical and financial burden, is expected to grow in incidence globally. Median survival from diagnosis is 3.8 years, and many of these patients succumb to a rapid death within 6 months. Despite the fatal prognosis, we have found that patients and caregivers often fail to understand the poor prognosis as the disease relentlessly progresses...
2018: BMJ Open Respiratory Research
Winnie Y Zou, Hashem B El-Serag, Yvonne H Sada, Sarah L Temple, Shubhada Sansgiry, Fasiha Kanwal, Jessica A Davila
BACKGROUND: Hospice provides integrative palliative care for advance-staged hepatocellular carcinoma (HCC) patients, but hospice utilization in HCC patients in the USA is not clearly understood. AIMS: We examined hospice use and subsequent clinical course in advance-staged HCC patients. METHODS: We conducted a retrospective study on a national, Veterans Affairs cohort with stage C or D HCC. We evaluated demographics, clinical factors, treatment, and clinical course in relation to hospice use...
March 5, 2018: Digestive Diseases and Sciences
Lesley Dunleavy, Catherine Walshe, Anna Oriani, Nancy Preston
BACKGROUND: Effective recruitment to randomised controlled trials is critically important for a robust, trustworthy evidence base in palliative care. Many trials fail to achieve recruitment targets, but the reasons for this are poorly understood. Understanding barriers and facilitators is a critical step in designing optimal recruitment strategies. AIM: To identify, explore and synthesise knowledge about recruitment barriers and facilitators in palliative care trials using the '6 Ps' of the 'Social Marketing Mix Framework'...
February 1, 2018: Palliative Medicine
Maria Kelly, Katie M O'Brien, Michael Lucey, Kerri Clough-Gorr, Ailish Hannigan
BACKGROUND: Analysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis...
February 26, 2018: BMC Palliative Care
Bridget Johnston, Anne Patterson, Lydia Bird, Eleanor Wilson, Kathryn Almack, Gillian Mathews, Jane Seymour
BACKGROUND: The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites...
February 23, 2018: BMC Palliative Care
J Nicholas Dionne-Odom, Richard Taylor, Gabrielle Rocque, Carol Chambless, Thomas Ramsey, Andres Azuero, Nataliya Ivankova, Michelle Y Martin, Marie A Bakitas
CONTEXT: There is a scarcity of early palliative care interventions to support family caregivers of persons with advanced cancer living in the rural Southern U.S.. OBJECTIVE: Adapt the content, format, and delivery of a six session, palliative care, telehealth intervention with monthly follow-up for rural family caregivers to enhance their own self-care and caregiving skills. METHODS: Qualitative formative evaluation consisting of one-on-one, semi-structured interviews with rural-dwelling persons with metastatic cancer (n=18), their primary family caregiver (n=20), and lay patient navigators (n=26) were conducted to elicit feedback on a family caregiver intervention outline based on published evidence-based interventions...
February 20, 2018: Journal of Pain and Symptom Management
Marie Lavesen, Kristoffer Bastrup-Madsen Marsa, Dorthe Gaby Bove
Patients with chronic obstructive pulmonary disease (COPD) often live with unmet palliative needs and low quality of life, although several guidelines recommend that those with COPD should be offered early and integrated palliative care. However, none of the guidelines describe how these recommendations can be operationalised and the current literature offers little information about experiences with developing and implementing new palliative care services. This article offers insight into the experience of developing and implementing a new palliative outpatient structure for patients with severe COPD...
February 2, 2018: International Journal of Palliative Nursing
Christopher M Wilson, Christina L Mitchell, Katherine M Hebert
Cerebellar stroke increases the risk of extensive physical disability and long-term institutionalization. The purpose of this case report is to describe the 14-month longitudinal rehabilitation management and outcomes from the intensive care unit, inpatient rehabilitation unit and outpatient care of a patient after cerebellar stroke. A goal of this case report is to provide rehabilitation clinicians with a long-term perspective and understanding of the course of recovery for a patient after cerebellar cerebrovascular accident or related injury...
December 14, 2017: Curēus
David B Bekelman, Rachel Johnson-Koenke, Daniel W Bowles, Stacy M Fischer
BACKGROUND: Patients with cancer could benefit from early primary (i.e., basic) palliative care. Scalable models of care delivery are needed. OBJECTIVE: Examine the feasibility of a stepped peer navigator and social work intervention developed to improve palliative care outcomes. DESIGN: Single-arm prospective clinical trial. The peer navigator educated patients to advocate for pain and symptom management with their healthcare providers, motivated patients to pursue advance care planning, and discussed the role of hospice...
February 20, 2018: Journal of Palliative Medicine
Erica C Kaye, Jonathan Jerkins, Courtney A Gushue, Samantha DeMarsh, April Sykes, Zhaohua Lu, Jennifer M Snaman, Lindsay Blazin, Liza-Marie Johnson, Deena R Levine, R Ray Morrison, Justin N Baker
CONTEXT: Early integration of palliative care (PC) in the management of children with high-risk cancer is widely endorsed by patients, families, clinicians, and national organizations. However, optimal timing for PC consultation is not standardized, and variables that influence timing of PC integration for children with cancer remain unknown. OBJECTIVES: To investigate associations between demographic, disease, treatment, and end-of-life attributes and timing of PC consultation for children with high-risk cancer enrolled on a PC service...
February 7, 2018: Journal of Pain and Symptom Management
Julia E Szymczak, Theodore Schall, Douglas L Hill, Jennifer K Walter, Shefali Parikh, Concetta DiDomenico, Chris Feudtner
CONTEXT: Pediatric palliative care consults for children with cancer often occur late in the course of disease and close to death, when earlier involvement would reduce suffering. The perceptions that pediatric oncology providers hold about the pediatric palliative care service (PPCS) may shape referral patterns. OBJECTIVE: To explore how pediatric oncology providers at one institution perceived the hospital's PPCS and the way these perceptions may influence the timing of consultation...
February 6, 2018: Journal of Pain and Symptom Management
Jun Wan, Shiping Xu, Yinqiao Wu, Benyan Wu, Dezhong Joshua Liao, Ningzhi Xu, Gangshi Wang
Treatment and management of cancers in elderly patients require some special considerations. A better understanding of how cancers progress in those elderly patients who have not received any anticancer treatments could better help us in treating these patients and in making end-of-life decisions. Over the past years, we had encountered 57 elderly patients, aged 75 to 94 years (87.6 on average), with a cancer in the digestive system, who refused to accept anticancer treatment but who did receive the best available supportive and palliative care...
February 7, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Grace Meijuan Yang, Irene Teo, Shirlyn Hui-Shan Neo, Daniel Tan, Yin Bun Cheung
CONTEXT: New models of care that are effective and feasible for widespread implementation need to be developed for the delivery of early palliative care to patients with advanced cancer. OBJECTIVES: The objectives were to determine the feasibility and acceptability of the Enhancing Quality of Life in Patients (EQUIP) intervention, data completion rate of patient-reported outcome measures in the context of the EQUIP trial, and the estimated effect of the EQUIP intervention on quality of life and mood...
January 1, 2018: American Journal of Hospice & Palliative Care
Gaëlle Vanbutsele, Koen Pardon, Simon Van Belle, Veerle Surmont, Martine De Laat, Roos Colman, Kim Eecloo, Veronique Cocquyt, Karen Geboes, Luc Deliens
BACKGROUND: The benefit of early integration of palliative care into oncological care is suggested to be due to increased psychosocial support. In Belgium, psychosocial care is part of standard oncological care. The aim of this randomised controlled trial is to examine whether early and systematic integration of palliative care alongside standard psychosocial oncological care provides added benefit compared with usual care. METHODS: In this randomised controlled trial, eligible patients were 18 years or older, and had advanced cancer due to a solid tumour, an European Cooperative Oncology Group performance status of 0-2, an estimated life expectancy of 12 months, and were within the first 12 weeks of a new primary tumour or had a diagnosis of progression...
February 2, 2018: Lancet Oncology
Shan Mohammed, Nadia Swami, Ashley Pope, Gary Rodin, Breffni Hannon, Rinat Nissim, Sarah Hales, Camilla Zimmermann
OBJECTIVE: To describe bereaved caregivers' experiences of providing care at home for patients with advanced cancer, while interacting with home care services. METHODS: Caregivers of patients who had completed a 4-month randomized controlled trial of early palliative care versus standard oncology care were recruited 6 months to 5 years after the patient's death. All patients except one (control) had eventually received palliative care. In semi-structured interviews, participants were asked about their experiences of caregiving...
February 1, 2018: Psycho-oncology
Ryan D Nipp, Areej El-Jawahri, Lara Traeger, Jamie M Jacobs, Emily R Gallagher, Elyse R Park, Vicki A Jackson, William F Pirl, Jennifer S Temel, Joseph A Greer
BACKGROUND: Early palliative care interventions enhance patient outcomes, including quality of life, mood, and coping, but it remains unclear whether certain subgroups of patients are more likely to benefit from early palliative care. We explored whether age and sex moderate the improved outcomes seen with early palliative care. METHODS: We performed a secondary analysis of data from a randomized trial of 350 patients with advanced lung and non-colorectal gastrointestinal cancer...
January 1, 2018: Palliative Medicine
Ana Carolina Lima Ramos Cardoso, Diego Dias de Araújo, Tânia Couto Machado Chianca
OBJECTIVES: to estimate the prevalence of impaired tactile sensory perception, identify risk factors, and establish a risk prediction model among adult patients receiving antineoplastic chemotherapy. METHOD: historical cohort study based on information obtained from the medical files of 127 patients cared for in the cancer unit of a private hospital in a city in Minas Gerais, Brazil. Data were analyzed using descriptive and bivariate statistics, with survival and multivariate analysis by Cox regression...
January 8, 2018: Revista Latino-americana de Enfermagem
Maria Paola Brugnoli, Giancarlo Pesce, Emanuela Pasin, Maria Francesca Basile, Stefano Tamburin, Enrico Polati
BACKGROUND: Patients with severe chronic diseases and advanced cancer receiving palliative care, have a complex range of pain and anxiety that can arise early in the course of illness. We studied two groups of patients with severe chronic diseases who participated in a nonrandomized clinical trial of early integration of clinical hypnosis in palliative care versus standard pharmacological care. The purpose of this investigation was to evaluate whether a long-term intervention of 2 years with clinical hypnosis and self-hypnosis as an adjuvant therapy in chronic pain and anxiety, is more effective than pharmacological therapy alone...
January 2018: Annals of Palliative Medicine
Sandra A Mitchell
PURPOSE OF REVIEW: The purpose of this review is to synthesize recent literature regarding the provision of palliative care to patients during and following allogeneic hematopoietic stem cell transplantation (HSCT), highlighting factors which mediate impairments in health-related quality of life in this patient population, and the intervention approaches and models of care delivery that clinicians can consider to address unmet needs for palliative care and to strengthen patient and family resiliency...
March 2018: Current Opinion in Supportive and Palliative Care
Georgia L Narsavage, Yea-Jyh Chen, Bettina Korn, Ronit Elk
Based on the demonstrated effectiveness of palliative care in the alleviation of symptoms and enhancement of life quality, it is important to incorporate palliative care early in the respiratory disease trajectory. Quality palliative care addresses eight domains that are all patient and family centred. Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea, cough, haemoptysis, sputum production, fatigue and respiratory secretion management, especially as the end-of-life nears...
December 2017: Breathe
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