Quality and palliative care

Heart failure is a chronic, progressive illness that is increasing in prevalence in the USA. Patients with advanced heart failure experience a high symptom burden that is comparable to patients with advanced cancer. Palliative care, however, is underutilized in patients with heart failure, and symptoms may go untreated as the disease progresses. A combination of pharmacologic and non-pharmacologic interventions should be used to address symptoms and maintain quality of life. While there have been significant advances in evidence-based heart failure treatments in recent years, selection of appropriate palliative medications as symptoms progress is challenging due to limited clinical studies in this patient population...

Palliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others and lead to moral distress. Understanding the pressures that PC clinicians face and the resources that could be employed to ease their moral distress is crucial to maintaining a healthy PC workforce and to providing necessary PC services to patients. In this paper, we discuss recommendations related to two promising pathways for supporting PC clinicians in providing high-quality PC: (1) improving systemic PC delivery and (2) strategies to promote ethical practice environments and individual resilience...

BACKGROUND: Exposure to the death and dying of others is an anxiety-provoking condition that can contribute to psychological stress. However, the results of empirical studies that evaluated work-related outcomes among physicians and nurses with repeated exposure to dying patients are not consistent. OBJECTIVE: Our aim was to evaluate whether a high level of exposure to death and dying (LED) can increase the risk for poor professional quality of life (ProQoL) in most healthcare workers, but it can also improve ProQoL in a subset of healthcare workers with specific characteristics...

Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors...

Providing end-of-life care to patients suffering from chronic kidney disease (CKD) and/or end-stage renal disease often presents ethical challenges to families and health care providers. However, as the conditions these patients present with are multifaceted in nature, so should be the approach when determining prognosis and treatment strategies for this patient population. Having an interdisciplinary palliative team in place to address any concerns that may arise during conversations related to end-of-life care encourages effective communication between the patient, the family and the medical team...

Renal Supportive Care is an alternative treatment pathway in advanced Chronic Kidney Disease (CKD) that is being increasingly adopted, particularly in the elderly. RSC utilises principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non-dialysis pathway. Nutrition management is often an under-recognised component of care, and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of RSC are met...

Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind-body techniques that are often used in the adult population for pain and symptom management...

BACKGROUND: Despite the documented benefits of palliative and hospice care on improving patients' quality of life, these services remain underutilized. Multiple factors limit the utilization of these services, including patients' and caregivers' lack of knowledge and misperceptions. OBJECTIVES: To examine palliative and hospice care awareness, misperceptions, and receptivity among community-dwelling adults. DESIGN: Cross-sectional study. SUBJECTS: New York State residents ≥18 years old who participated in the 2016 Empire State Poll...

Patients with oncological diseases, especially palliative care patients, suffer from physical and psychological difficulties. The quality of life of such patients is bad, they do not have purpose to live and they feel anxiety and distress. In 1959 Victor Frankl wrote the book Man's Search for Meaning in which he stated that the driving force of human life lay in the ability to discern the meaning of faith and spirituality. Inspired by Frankl's ideas, the American psychiatrist William Breitbart with colleagues have developed both an individual and group model of Meaning-Centered Psychotherapy...

Physician assisted suicide and euthanasia (PAS/E) has been increasingly discussed and debated in the public square, including in professional medical organizations. However, the medical student perspective on the debate has been essentially absent. We present a medical student perspective on the PAS/E debate as future doctors and those about to enter the profession. We argue that PAS/E is not in line with the core principles of medicine, and the focus should rather be on providing high-quality end-of-life and palliative care...

Dialysis initiation rates among older adults, aged 75 years or greater, are increasing at a faster rate than for younger age groups. Older adults with advanced CKD (eGFR < 30 ml/min/1.73 m(2)) typically lose renal function slowly, often suffer from significant comorbidity and thus may die from associated comorbidities before they require dialysis.A patient's pattern of renal function loss over time in relation to their underlying comorbidities can serve as a guide to the probability of a future dialysis requirement...

BACKGROUND: Palliative care is associated with improved patient and family outcomes and lower cost of care, but studies estimate that <50% of hospitalized adults in the United States who are appropriate for palliative care receive it. Few studies have addressed demographic and clinical factors associated with receipt of palliative care. OBJECTIVE: Our aim was to identify characteristics of hospitalized advanced cancer patients that are associated with referral to an interdisciplinary hospital-based palliative care team...

PURPOSE: To inform health system improvements for care of elderly populations approaching the end of life (EOL) by identifying important elements of care and implementation barriers and facilitators. DESIGN: A scoping review was carried out to identify key themes in EOL care. Articles were identified from MEDLINE, the Cochrane Library, organizational websites, and internet searches. Eligible publications included reviews, reports, and policy documents published between 2005 and 2016...

BACKGROUND: Symptom burden is common for long-term care residents with dementia which if untreated compromises quality of life. Measurement tools can support assessment of symptoms and problems but are not widely used in long-term care settings. We developed the Integrated Palliative care Outcome Scale for Dementia derived from the Palliative care Outcome Scale, Palliative care Outcome Scale-Symptom and Integrated Palliative care Outcome Scale. AIM: To examine the content validity, acceptability and comprehension of Integrated Palliative care Outcome Scale for Dementia for routine use in long-term care settings for people with dementia and to refine Integrated Palliative care Outcome Scale for Dementia...

Our society is characterized by increasing diversity. Immigrants greatly contribute to this diversification. Currently, one fifth of the population in Germany is considered to be of immigrant origin. Healthcare needs of immigrants are often not sufficiently taken into account by healthcare institutions. This may result in many barriers encountered by immigrants in the healthcare system, which may affect the utilization and quality of care. These barriers are particularly pronounced in nursing and palliative care...

Aim of the study Due to the aging population in Germany, the need for palliative care institutions will increase. Considering the lack of resources, work stress of palliative care nurses could increase significantly. It was the aim of this study to identify risk factors for job overload and work stress of palliative care nurses in the inpatient and outpatient setting. Methods In cooperation with the KOMPACT Working Group, we conducted an anonymous survey of palliative care givers in Baden-Württemberg, Germany...

PURPOSE OF REVIEW: Cough is a common and distressing symptom. It has a marked decrement on quality-of-life particularly in the arena of palliative care where coexisting symptoms such as pain may be exacerbated. Whilst local definitive treatment may alleviate coughing it usually requires general measures. The purpose of the review is to assess the current evidence relating to the pharmacological management of cough. RECENT FINDINGS: Key to understanding cough is the realization that most cough is because of a hypersensitivity of the afferent vagus nerve...

BACKGROUND: Studies indicate that symptoms attributable to impaired kidney function are important determinants of quality of life and functional status in patients with chronic kidney disease (CKD). Accordingly, symptom assessment and subsequent control are prerequisites of high-quality care in this patient population. Whilst symptom burden in patients with advanced CKD managed without dialysis has been likened to that of palliative care cancer populations, there is little information about the nature and range of symptoms in earlier stages of the CKD trajectory...

BACKGROUND: At the time of diagnosis, most patients with acute myeloid leukemia are older than 65 years of age. Treatment of this group of patients is challenging because they become less tolerant to aggressive chemotherapy with increasing age. Less than one-third of elderly patients are considered eligible for intensive treatment; nevertheless, the survival analysis for this population remains poor. Due to numerous comorbidities and an overall deteriorating condition, most elderly patients with acute myeloid leukemia receive only palliative or best supportive care, which are associated with a high mortality rate...

INTRODUCTION: Advanced cancer patients participating in phase 1 clinical trials experience considerable symptom burden. Palliative care (PC) may benefit these individuals by providing supportive care during clinical research participation. This study investigates integration of a PC intervention among phase 1 trial participants with advanced cancer. METHODS AND MATERIALS: This study is a multisite randomized clinical trial testing a concurrent PC intervention among phase 1 trial participants...