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Outpatient palliative care

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https://www.readbyqxmd.com/read/28644706/advance-care-planning-and-palliative-care-integration-for-patients-undergoing-hematopoietic-stem-cell-transplantation
#1
Winnie S Wang, Joseph D Ma, Sandahl H Nelson, Carolyn Revta, Gary T Buckholz, Carolyn M Mulroney, Eric J Roeland
PURPOSE: Advance care planning (ACP) in hematopoietic stem-cell transplantation (HSCT) is challenging, given the potential for cure despite increased morbidity and mortality risk.The aim of this study was to evaluate ACP and palliative care (PC) integration for patients who underwent HSCT. METHODS: A retrospective analysis was conducted and data were extracted from electronic medical records of patients who underwent HSCT between January 2011 and December 2015. Patients who received more than one transplant and who were younger than 18 years of age were excluded...
June 23, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28629462/treatment-decisions-for-older-adults-with-advanced-chronic-kidney-disease
#2
REVIEW
Steven J Rosansky, Jane Schell, Joseph Shega, Jennifer Scherer, Laurie Jacobs, Cecile Couchoud, Deidra Crews, Matthew McNabney
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...
June 19, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28625164/the-effect-of-weekly-specialist-palliative-care-teleconsultations-in-patients-with-advanced-cancer-a-randomized-clinical-trial
#3
Patrick D Hoek, Henk J Schers, Ewald M Bronkhorst, Kris C P Vissers, Jeroen G J Hasselaar
BACKGROUND: Teleconsultation seems to be a promising intervention for providing palliative care to home-dwelling patients; however, its effect on clinically relevant outcome measures remains largely unexplored. Therefore, the purpose of this study was to determine whether weekly teleconsultations from a hospital-based specialist palliative care consultation team (SPCT) improved patient-experienced symptom burden compared to "care as usual". Secondary objectives were to determine the effects of these teleconsultations on unmet palliative care needs, continuity of care, hospital admissions, satisfaction with teleconsultations, and the burden experienced by informal caregivers...
June 19, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28614896/-quality-of-life-and-potential-incriminating-factors-among-palliative-care-givers-a-german-survey-of-the-kompact-working-group
#4
Deniz Gencer, Cornelia Meffert, Peter Herschbach, Matthias Hipp, Gerhild Becker
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...
June 14, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28604233/distance-education-methods-are-useful-for-delivering-education-to-palliative-caregivers-a-single-arm-trial-of-an-education-package-palliative-caregivers-education-package
#5
Liz Forbat, Rowena Robinson, Rachel Bilton-Simek, Karemah Francois, Marsha Lewis, Erna Haraldsdottir
BACKGROUND: Face-to-face/group education for palliative caregivers is successful, but relies on caregivers travelling, being absent from the patient, and rigid timings. This presents inequities for those in rural locations. AIM: To design and test an innovative distance-learning educational package (PrECEPt: PalliativE Caregivers Education Package). DESIGN: Single-arm mixed-method feasibility proof-of-concept trial (ACTRN12616000601437). The primary outcome was carer self-efficacy, with secondary outcomes focused on caregiver preparedness and carer tasks/needs...
June 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28598227/integration-of-a-palliative-care-intervention-into-community-practice-for-lung-cancer-a-study-protocol-and-lessons-learned-with-implementation
#6
Huong Q Nguyen, Thomas Cuyegkeng, Tieu O Phung, Karisa Jahn, Tami Borneman, Mayra Macias, Nora Ruel, Betty Ferrell
BACKGROUND: A notable gap in the evidence base for outpatient palliative care (PC) for cancer is that most trials were conducted in specialized oncology or academic centers with limited translation and further evaluation in "real-world" settings. Health systems are desperate for guidance regarding the most effective and sustainable PC service models. OBJECTIVE: Describe the study protocol to evaluate the dissemination of a previously tested nurse-led PC intervention (PCI) for patients with lung cancer and their family caregiver in community-based settings, lessons learned in adapting and implementing the PCI, and implications for future dissemination-translational efforts Design: Two-group, prospective sequential, quasi-experimental design with Phase 1 (Usual care) followed by Phase 2 (Intervention) setting/subjects...
June 9, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28595446/life-perceptions-of-patients-receiving-palliative-care-and-experiencing-psycho-social-spiritual-healing
#7
Lingsheng Li, Danetta H Sloan, Ambereen K Mehta, Gordon Willis, Meaghann S Weaver, Ann C Berger
BACKGROUND: It is important to identify, from the patients' perspectives, the different factors that contribute toward psycho-social-spiritual healing. METHODS: This was a qualitative study that took place at a large research center, an underserved clinic, and a community hospital. We used a needs assessment questionnaire and open-ended questions to assess the constituents of psycho-social-spiritual healing: (I) how previous life experiences affected patients' present situations in dealing with their illnesses; (II) barriers to palliative care, and (III) benefits of palliative care...
June 3, 2017: Annals of Palliative Medicine
https://www.readbyqxmd.com/read/28595027/clinical-outcomes-of-start-low-go-slow-methadone-initiation-for-cancer-related-pain-what-s-the-hurry
#8
Pippa Hawley, Lawrance Chow, Gillian Fyles, Aria Shokoohi, Mary-Jane O'Leary, Matthew Mittelstadt
BACKGROUND: Methadone has been shown to be effective for cancer pain. Most published switching methods are complete in less than three days, requiring very close supervision, usually in an inpatient setting. This need for hospitalization is a barrier to access. We present a large retrospective study of slow outpatient methadone starts and describe our starting method. METHODS: Charts were reviewed of patients referred to the Pain and Symptom Management/Palliative Care clinics at the six BC Cancer Agency's regional centers that underwent initiation of methadone for analgesia over a 14-year period...
June 8, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28594585/impact-of-palliative-medicine-involvement-on-end-of-life-services-for-patients-with-cancer-with-in-hospital-deaths
#9
Alison Wiesenthal, Debra A Goldman, Deborah Korenstein
PURPOSE: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. METHODS: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death...
June 8, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28585274/junior-doctors-attitudes-to-opioids-for-refractory-breathlessness-in-patients-with-advanced-chronic-obstructive-pulmonary-disease
#10
Natasha Smallwood, Nicole Gaffney, Alexandra Gorelik, Louis Irving, Brian Le, Jennifer Philip
Refractory breathlessness is a common, distressing symptom in patients with advanced chronic obstructive pulmonary disease (COPD). The judicious, off-licence prescription of opioids, together with other management strategies, can improve breathlessness, however, internationally there is profound reluctance to prescribe opioids for breathlessness in COPD. AIMS: To understand Australian junior doctors' knowledge and attitudes regarding the management of refractory breathlessness and the role of opioids in COPD...
June 6, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28562197/improving-end-of-life-care-palliative-care-embedded-in-an-oncology-clinic-specializing-in-targeted-and-immune-based-therapies
#11
David J Einstein, Susan DeSanto-Madeya, Matthew Gregas, Jessica Lynch, David F McDermott, Mary K Buss
PURPOSE: Patients with advanced cancer benefit from early involvement of palliative care. The ideal method of palliative care integration remains to be determined, as does its effectiveness for patients treated with targeted and immune-based therapies. MATERIALS AND METHODS: We studied the impact of an embedded palliative care team that saw patients in an academic oncology clinic specializing in targeted and immune-based therapies. Patients seen on a specific day accessed the embedded model, on the basis of automatic criteria; patients seen other days could be referred to a separate palliative care clinic (usual care)...
May 31, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28562160/work-experiences-of-patients-receiving-palliative-care-at-a-comprehensive-cancer-center-exploratory-analysis
#12
Paul A Glare, Tanya Nikolova, Alberta Alickaj, Sujata Patil, Victoria Blinder
BACKGROUND: Employment-related issues have been largely overlooked in cancer patients needing palliative care. These issues may become more relevant as cancer evolves into more of a chronic illness and palliative care is provided independent of stage or prognosis. OBJECTIVE: To characterize the employment situations of working-age palliative care patients. DESIGN: Cross-sectional survey setting/subjects: Consecutive sample of 112 patients followed in palliative care outpatient clinics at a comprehensive cancer center...
May 31, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28558731/integration-and-activity-of-hospital-based-palliative-care-consultation-teams-the-insight-multicentric-cohort-study
#13
Pascale Vinant, Ingrid Joffin, Laure Serresse, Sophie Grabar, Hélène Jaulmes, Malika Daoud, Gabriel Abitbol, Pascale Fouassier, Isabelle Triol, Sylvie Rostaing, Marie-Dominique Brette, Isabelle Colombet
BACKGROUND: Hospital-based Palliative Care Consultation Teams (PCCTs) have a consulting role to specialist services at their request. Referral of patients is often late. Early palliative care in oncology has shown its effectiveness in improving quality of life, thereby questioning the "on request" model of PCCTs. Whether this evidence changed practice is unknown. This multicentre prospective cohort study aims to describe the activity and integration of PCCTs at the patient level. METHODS: For consecutive patients newly referred to participating PCCTs, the team collected the following data: circumstances of first referral, problems identified, number of interventions, patient's survival after first evaluation and place of death...
May 30, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28557661/opioids-in-cancer-pain-right-or-privilege
#14
Leanne K Jackson, Syed N Imam, Ursula K Braun
Opioid analgesia is a mainstay of the treatment of cancer pain. Treatment of pain in patients with cancer with an ongoing substance abuse disorder can be difficult. We report the ethical challenges of treating a patient with cancer with a concomitant substance abuse disorder in an outpatient palliative care setting. We present an analysis of ethical considerations for the palliative care physician and strategies to aid in the successful treatment of such patients. We argue that there are select patients with cancer for whom exclusion from treatment with opioid therapy is warranted if their health is endangered by prescription of these medications...
May 30, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28501134/factors-associated-with-palliative-care-use-in-patients-undergoing-cytoreductive-surgery-and-hyperthermic-intraperitoneal-chemotherapy
#15
Rachel S Morris, Faiz Gani, Abdulrahman Y Hammad, Wendy Peltier, T Clark Gamblin, Kiran K Turaga, Fabian M Johnston
BACKGROUND: Peritoneal carcinomatosis represents widespread metastatic disease throughout the abdomen and/or pelvis. Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves the overall survival compared to standard therapy alone. The role palliative care (PC) plays however, remains poorly studied among these patients. METHODS: Patients who had previously undergone HIPEC and who underwent an inpatient admission from 7/1/2013 to 6/30/2014 were identified to determine which patients were referred for inpatient or outpatient palliative consultation...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28494619/improving-quality-of-care-for-end-stage-respiratory-disease-changes-in-attitude-changes-in-service
#16
D Robin Taylor, Scott A Murray
The illness trajectory for many patients with severe respiratory disease is characterized by steady decline. Yet most healthcare resources are poured into managing acute exacerbations that are only temporarily effective. Further, 'bad deaths' can result from inappropriate medical interventions at times of crisis. In this article, we describe a range of changes in attitudes, behaviour and service provision that together focus on improving quality of care for respiratory patients with frequent crises. These changes include prognostic conversations, developing and implementing anticipatory care plans both in hospital and in the outpatient settings, and establishing a supportive care clinic devoted to complex disease and optimizing palliative care...
January 1, 2017: Chronic Respiratory Disease
https://www.readbyqxmd.com/read/28485714/portugal-health-system-review
#17
Jorge de Almeida Simoes, Goncalo Figueiredo Augusto, Ines Fronteira, Cristina Hernandez-Quevedo
This analysis of the Portuguese health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Overall health indicators such as life expectancy at birth and at age 65 years have shown a notable improvement over the last decades. However, these improvements have not been followed at the same pace by other important dimensions of health: child poverty and its consequences, mental health and quality of life after 65...
March 2017: Health Systems in Transition
https://www.readbyqxmd.com/read/28478889/-interventions-to-improve-quality-of-life-in-oncological-patients
#18
Monika Klinkhammer-Schalke, Brunhilde Steinger, Michael Koller, Patricia Lindberg
The assessment of quality of life is a central aspect in the current debate in support groups, certified cancer centres, benefit assessment, and also in palliative care. Accordingly, quality of life has become an essential part of clinical trials for more than two decades. But most of the time results are presented in a descriptive manner without any concrete therapeutic consequences for the improvement of quality of life. Likewise, there are no uniform recommendations for considering quality of life data in the decision-making process...
May 3, 2017: Zeitschrift Für Evidenz, Fortbildung und Qualität Im Gesundheitswesen
https://www.readbyqxmd.com/read/28472313/implementing-evidence-based-palliative-care-programs-and-policy-for-cancer-patients-epidemiologic-and-policy-implications-of-the-2016-american-society-of-clinical-oncology-clinical-practice-guideline-update
#19
Sarina R Isenberg, Rebecca A Aslakson, Thomas J Smith
The American Society of Clinical Oncology (ASCO) recently convened an Ad Hoc Palliative Care Expert Panel to update a 2012 provisional clinical opinion by conducting a systematic review of clinical trials in palliative care in oncology. The key takeaways from the updated ASCO clinical practice guidelines (CPGs) are that more people should be referred to interdisciplinary palliative care teams and that more palliative care specialists and palliative care-trained oncologists are needed to meet this demand. The following summary statement is based on multiple randomized clinical trials: "Inpatients and outpatients with advanced cancer should receive dedicated palliative care services, early in the disease course, concurrent with active treatment...
January 1, 2017: Epidemiologic Reviews
https://www.readbyqxmd.com/read/28470369/integration-of-oncology-and-palliative-care-setting-a-benchmark
#20
P Vayne-Bossert, E Richard, P Good, K Sullivan, J R Hardy
BACKGROUND: Integration of oncology and palliative care (PC) should be the standard model of care for patients with advanced cancer. An expert panel developed criteria that constitute integration. This study determined whether the PC service within this Health Service, which is considered to be fully "integrated", could be benchmarked against these criteria. METHODS: A survey was undertaken to determine the perceived level of integration of oncology and palliative care by all health care professionals (HCPs) within our cancer centre...
May 3, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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