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Outpatient palliative care

Emilia Ip, Adrian M J Pokorny, Stephen Della-Fiorentina, Philip Beale, Victoria Bray, Belinda E Kiely, Prunella Blinman
BACKGROUND: Octogenarians represent a growing population reviewed in medical oncology clinics, yet there is a paucity of data on how chemotherapy is tolerated in this age group. AIM: To describe the use of palliative first-line chemotherapy in patients 80 years and over, and factors associated with its use. METHODS: We identified all new patients aged 80 years or older diagnosed with incurable advanced solid organ cancer, and seen in one of three Sydney medical oncology outpatient clinics between January 2009 and December 2013...
October 17, 2016: Internal Medicine Journal
Joseph Arthur, Sriram Yennu, Kresnier Perez Zapata, Hilda Cantu, Jimin Wu, Diane Liu, Eduardo Bruera
BACKGROUND: Data on the use of question prompt sheets (QPS) in palliative care is limited. Our team previously developed a single page QPS using a Delphi process. The main objective of this study was to determine the perception of helpfulness of a QPS in patient-physician communication among advanced cancer outpatients. METHODS: 100/104(96%) eligible patients and 68/68(100%) caregivers received the QPS during their first palliative care clinic. 12 palliative medicine specialists also participated in the study...
October 12, 2016: Journal of Pain and Symptom Management
Maxine de la Cruz, Akhila Reddy, Vishidha Balankari, Margeaux Epner, Susan Frisbee-Hume, Jimin Wu, Diane Liu, Sriram Yennurajalingam, Hilda Cantu, Janet Williams, Eduardo Bruera
BACKGROUND: Improper use, storage, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our previous study showed a large proportion of cancer patients have unsafe opioid practices. Our objective was to determine whether an improvement occurred in the patterns of use, storage, and disposal of opioids among cancer outpatients after the implementation of a patient educational program. PATIENTS AND METHODS: Our palliative care (PC) clinic provides every patient with educational material (EM) on safe opioid use, storage, and disposal every time they receive an opioid prescription...
October 14, 2016: Oncologist
Kimberson Tanco, Joseph Arthur, Ali Haider, Saneese Stephen, Sriram Yennu, Diane Liu, Eduardo Bruera
PURPOSE: The use of standardized pain classification systems such as the ECS-CP can assist in the assessment and management of cancer pain. However, its completion has been limited due to its perceived complexity of decoding each feature. The objectives of this study were to determine the rate of clinician documentation and completion of the ECS-CP features after revision and simplification of the response for each feature. METHODS: Electronic records of consecutive patient visits at the outpatient supportive care center seen by 12 palliative medicine specialists were collected at 6 months before (pre-interventional period), 6 and 24 months after (post-interventional period) the implementation of the simplified ECS-CP tool...
October 8, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Julie C McDonald, Jeanne M du Manoir, Nanor Kevork, Lisa W Le, Camilla Zimmermann
PURPOSE: The purposes of the study were to assess awareness and prevalence of advance directives (ADs) among patients with advanced cancer undergoing active outpatient care and to determine factors associated with AD completion before and after the diagnosis of cancer. METHODS: Patients with advanced solid tumor malignancy receiving treatment at the Chemotherapy Day Unit were approached for recruitment. They completed an onsite questionnaire about completion and timing of ADs, demographic information, and perceived health; a review of their medical records was conducted to document their cancer care and co-morbidities...
October 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Brian Scott Carter
No abstract text is available yet for this article.
September 29, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
Ravi B Parikh, Brynn Bowman, Constance Dahlin, Jeanne S Twohig, Diane E Meier
Early, integrated palliative care has been shown to improve quality of life and reduce utilization in both inpatient and outpatient settings. As health systems shift to risk-based payment structures, palliative care will play an increasing role in improving value of care outside of the hospital. Based on successful models of community-based palliative care, we identify six principles - interdisciplinary team-based care; 24/7 access and responsiveness; concurrent palliative care with disease-directed treatment; targeting services to high-risk patients; integrated medical and social supports; and caregiver support - that are widely implemented because of their impact on improving value for seriously ill individuals...
September 27, 2016: Healthcare
C Docherty, L Lester, S O'Reilly
Palliative care (PC) positively impacts patient outcomes, decreases hospital admissions and improves quality of life. Despite evidence, PC resources are reported as under-utilised. Few studies have explored patient attitudes towards PC. This study evaluated patient attitudes towards PC. It was a prospective study conducted in oncology outpatient clinics. A 26-item questionnaire was distributed to those with metastatic cancer (N = 44). Sixty percent believed PC can make people feel better, 63.4% believed PC is offered when nothing more can be done...
2016: Irish Medical Journal
Véronique Bourg, Anne Descotes, Anne Pagnier, Jacques Griffet, Dominique Plantaz
The Child and Family Hospital of Grenoble is one of the rare university hospitals in France to benefit from the presence of a physician specializing in rehabilitation medicine. This hospital includes both inpatient and outpatient units. During the temporary closure of one department, certain members of the rehabilitation unit were reassigned to the acute care wards of the pediatric department, including physical therapists, occupational therapists, and speech therapists. Over the course of one year, these therapists completed more than 150 interventions in this department, more than half of which were in the hematology and oncology ward...
September 2016: Annals of Physical and Rehabilitation Medicine
Panagiotis Zis, Nikolitsa Bernali, Erifili Argira, Ioanna Siafaka, Athina Vadalouka
BACKGROUND: Capsaicin 8% patch (Qutenza™) is mainly used to treat postherpetic neuralgia and HIV-associated neuropathy. Evidence of the efficacy of Qutenza in other forms of neuropathic pain is lacking. OBJECTIVE: To evaluate the analgesic effect and the impact on quality of life after a single application of the capsaicin 8% cutaneous patch in patients with lumbosacral pain. STUDY DESIGN: Prospective open-label study of capsaicin 8% patch in patients with lumbosacral pain...
September 2016: Pain Physician
A Brinkman-Stoppelenburg, M Boddaert, J Douma, A van der Heide
BACKGROUND: Palliative care expert teams in hospitals have positive effects on the quality of life and satisfaction with care of patients with advanced disease. Involvement of these teams in medical care is also associated with substantial cost savings. In the Netherlands, professional standards state that each hospital should have a palliative care team by 2017. We studied the number of hospitals that have a palliative care team and the characteristics of these teams. METHODS: In April 2015, questionnaires were mailed to key palliative care professionals in all general, teaching and academic hospitals in the Netherlands...
2016: BMC Health Services Research
Mark D Danese, Robert I Griffiths, Michelle L Gleeson, Tapashi Dalvi, Jingyi Li, Joseph R Mikhael, Robert Deeter, Martin Dreyling
Using SEER-Medicare linked data we identified elderly patients diagnosed with diffuse large B-cell lymphoma (DLBCL) between January 2000 and December 2007 who received second-line outpatient chemotherapy for relapsed or refractory disease. Second-line regimens were classified into three mutually exclusive groups: aggressive, conventional, and palliative. Of the 632 (426 relapsed, 206 refractory) patients in the cohort, 27.8% received aggressive second-line therapy, 39.1% received conventional therapy, and 33...
September 23, 2016: Leukemia & Lymphoma
Fleur Huang, Amy Driga, Bronwen E LeGuerrier, Renée Schmitz, Debra M Hall-Lavoie, Xanthoula Kostaras, Karen P Chu, Edith Pituskin, Sharon M Watanabe, Alysa Fairchild
Caring for patients with incurable cancer presents unique challenges. Managing symptoms that evolve with changing clinical status and, at the same time, ensuring alignment with patient goals demands specific attention from clinicians. With care needs that often transcend traditional service provision boundaries, patients who seek palliation commonly interface with a team of providers that represents multiple disciplines across multiple settings. In this case study, we explore some of the dynamics of a cross-disciplinary approach to symptom management in an integrated outpatient radiotherapy service model...
September 20, 2016: Journal of Oncology Practice
Susan C Miller, Roshani Dahal, Julie C Lima, Orna Intrator, Edward Martin, Janet Bull, Laura C Hanson
CONTEXT: While specialty palliative care in hospital and outpatient settings is associated with lower acute care use, its impact in U.S. nursing homes (NHs) is unknown. OBJECTIVES: To understand how NH use of palliative care consults is associated with end-of-life hospitalizations. METHODS: Seven consult providers in four states and 24 counties shared data on the number of consult visits and residents served (per NH) in study years 2000-2010...
September 17, 2016: Journal of Pain and Symptom Management
Stephanie Kukora, Nathan Gollehon, Naomi Laventhal
BACKGROUND: Some pregnant patients with complex fetal anomalies meet with paediatric palliative care subspecialists prior to delivery, but referral to antenatal palliative care consultation (APCC) is not standard. Little is known about its role in perinatal decision-making. METHODS: A single-centre retrospective cohort study was undertaken for patients referred for outpatient antenatal counselling by a neonatologist over a two-and-half-year period. Patients also receiving APCC were compared with infants with similar prognoses who did not...
September 16, 2016: Archives of Disease in Childhood. Fetal and Neonatal Edition
David B Bekelman, Larry A Allen, Jamie Peterson, Brack Hattler, Edward P Havranek, Diane L Fairclough, Connor F McBryde, Paula M Meek
While contemporary heart failure management has led to some improvements in morbidity and mortality, patients continue to report poor health status (i.e., burdensome symptoms, impaired function, and poor quality of life). The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial is a NIH-funded, three-site, randomized clinical trial that examines the effect of the CASA intervention compared to usual care on the primary outcome of patient-reported health status at 6months in patients with heart failure and poor health status...
September 12, 2016: Contemporary Clinical Trials
Omar Shamieh, Odai Khamash, Mustafa Khraisat, Omar Jbouri, Mohammad Awni, Abdulrahman Al-Hawamdeh, Ghadeer Arja, Sawsan Ajarmeh, Dalia Al-Rimawi, David Hui
PURPOSE: Outpatient palliative care clinics are essential for early symptom management in patients with advanced cancer. Few outpatient programs are available in the Middle East. In this prospective study, we examined the symptom changes among cancer patients seen at a palliative care clinic in Jordan. METHODS: Patients with advanced cancer who had an outpatient palliative care consultation and not delirious were enrolled. The Edmonton Symptom Assessment System (ESAS), Karnofsky Performance Scale (KPS), and Memorial Delirium Assessment Scale (MDAS) were collected at consultation and follow up visit 14-34 days later...
September 7, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Toru Okuyama, Yoshiyuki Kizawa, Tatsuya Morita, Hiroya Kinoshita, Megumi Uchida, Asami Shimada, Akemi Shirado Naito, Tatsuo Akechi
BACKGROUND: The purpose of this study was to investigate the current status of distress screening implementation in Japanese designated cancer hospitals. SUBJECTS AND METHODS: This was a cross-sectional observational study. Palliative care team representatives in all designated cancer hospitals in Japan completed an ad hoc questionnaire. Demographic data in 2014 were obtained from the Ministry of Health, Labour and Welfare in Japan. RESULTS: Of 422 institutions, 389 responded (92%) and data were obtained from 379 (90%)...
September 2016: Journal of the National Comprehensive Cancer Network: JNCCN
S T Simon, A Pralong, U Welling, R Voltz
BACKGROUND: In Germany the structures of generalized and specialized palliative care services have considerably increased over the last decade with respect to the number, quality and differentiation. The goal is to improve or to maintain the quality of life for patients with life-threatening illnesses. AIM: The current structures of generalized and specialized palliative care services in Germany are presented. MATERIAL AND METHODS: The structures of healthcare services are presented primarily based on the S3 guidelines on palliative care for patients with incurable cancer...
October 2016: Der Internist
Jason Lambden, Baohui Zhang, Robert Friedlander, Holly G Prigerson
BACKGROUND: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. OBJECTIVE: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. DESIGN: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death...
August 30, 2016: Journal of Palliative Medicine
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