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Primary palliative care

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https://www.readbyqxmd.com/read/28104470/a-cluster-randomized-trial-of-a-primary-palliative-care-intervention-connect-for-patients-with-advanced-cancer-protocol-and-key-design-considerations
#1
Claire L Becker, Robert M Arnold, Seo Young Park, Margaret Rosenzweig, Thomas J Smith, Douglas B White, Kenneth J Smith, Yael Schenker
BACKGROUND: The addition of specialty palliative care to standard oncology care improves outcomes for patients with advanced cancer and their caregivers, but many lack access to specialty care services. Primary palliative care-meaning basic palliative care services provided by clinicians who are not palliative care specialists-is an alternative approach that has not been rigorously evaluated. METHODS: A cluster randomized, controlled trial of the CONNECT (Care management by Oncology Nurses to address supportive care needs) intervention, an oncology nurse-led care management approach to providing primary palliative care for patients with advanced cancer and their family caregivers, is currently underway at 16 oncology practices in Western Pennsylvania...
January 16, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28097296/long-term-postprocedural-outcomes-of-palliative-emergency-stenting-vs-stoma-in-malignant-large-bowel-obstruction
#2
Jonathan S Abelson, Heather L Yeo, Jialin Mao, Jeffrey W Milsom, Art Sedrakyan
Importance: Colonic stenting was introduced for palliation of malignant large-bowel obstruction (MLBO) more than 20 years ago but remains controversial. Objective: To compare outcomes after palliative stenting vs stoma creation in patients with MLBO requiring emergency management. Design, Setting, and Participants: This observational cohort study assessed 345 patients from New York State with an urgent or emergency admission to the hospital for obstruction secondary to colorectal cancer and who underwent stenting or stoma creation from October 1, 2009, through December 31, 2013...
January 11, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28095943/sleep-disturbances-in-caregivers-of-patients-with-advanced-cancer-a-systematic-review
#3
Kirstin F Maltby, Christine R Sanderson, Elizabeth A Lobb, Jane L Phillips
OBJECTIVE: Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer. METHOD: An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed...
January 18, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28076258/perspectives-of-primary-care-providers-toward-palliative-care-for-their-patients
#4
David Nowels, Jacqueline Jones, Carolyn T Nowels, Daniel Matlock
PURPOSE: The need for all providers to deliver basic palliative care has emerged as patients' needs outstrip the capacity of specialty palliative care. Many patients with complex illnesses have unmet needs and are seen in primary care more than other settings. We explore primary care providers' willingness and perceived capacity to provide basic palliative care, and their concerns and perceived barriers. METHODS: We performed semistructured telephone interviews with 20 primary care providers about their perceptions of palliative care, including needs, practices, experiences, access, and what would be helpful for their practices to systematically provide basic palliative care...
November 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/28069153/working-in-silos-head-neck-cancer-patients-during-and-after-treatment-with-or-without-early-palliative-care-referral
#5
Helena Ullgren, Lily Kirkpatrick, Sini Kilpeläinen, Lena Sharp
PURPOSE: The primary aim was to describe patients with Head and Neck (H&N) cancer referred to palliative care and how the care transition from acute oncological to palliative care impacted on both Health related quality of life (HRQoL) and information. The secondary aim was to explore H&N cancer patients' HRQoL and perceived information. METHODS: H&N cancer patients were identified via the Swedish Cancer Register. Data were collected using the following questionnaires; European Organization for Research and Treatment of Cancer (EORTC) QLQ C-30, INFO25, and a study-specific questionnaire...
February 2017: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
https://www.readbyqxmd.com/read/28062420/jejunal-perforation-an-unusual-presentation-of-metastatic-cutaneous-squamous-cell-carcinoma-scc-in-an-immunosuppressed-patient
#6
N Hitchen, D Warnapala, R M Fisher, J Dua, P Pratsou, A Freebairn
We report the rare occurrence of a small bowel perforation secondary to a metastatic cutaneous squamous cell carcinoma (cSCC). A 70-year-old woman, who had previously undergone renal transplantation, presented with severe, sudden-onset abdominal pain. She was peritonitic on initial examination, with evidence of free intra-abdominal air on radiographic imaging. During an exploratory laparotomy, she was found to have a perforated jejunum secondary to disseminated metastases seen throughout her peritoneum. Following histopathological analysis, as well as further imaging studies, the primary malignancy was eventually identified as a cSCC on her upper back...
January 6, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28062344/prognostic-tools-in-patients-with-advanced-cancer-a-systematic-review
#7
REVIEW
Claribel P L Simmons, Donald C McMillan, Kerry McWilliams, Tonje A Sande, Kenneth C Fearon, Sharon Tuck, Marie T Fallon, Barry J Laird
PURPOSE: In 2005, the European Association for Palliative Care (EAPC) made recommendations for prognostic markers in advanced cancer. Since then, prognostic tools have been developed, evolved and validated. The aim of this systematic review was to examine the progress in the development and validation of prognostic tools. METHODS: Medline, Embase Classic + and Embase were searched. Eligible studies met the following criteria: patients with incurable cancer; >18 years; original studies; population n>100; published after 2003...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062333/electronic-goals-of-care-alerts-an-innovative-strategy-to-promote-primary-palliative-care
#8
Erin M Haley, Deborah Meisel, Yevgeniy Gitelman, Laura Dingfield, David J Casarett, Nina R O'Connor
CONTEXT: Given the shortage of palliative care specialists, strategies are needed to promote primary palliative care by non-palliative care providers. Electronic reminders are frequently used in medicine to standardize practice, but their effectiveness in encouraging goals of care discussions is not well understood. OBJECTIVES: To determine whether brief education and electronic alerts increase the frequency of goals of care discussions. METHODS: All general medicine services at a large academic medical center were included...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28056201/predictors-of-and-trends-in-high-intensity-end-of-life-care-among-children-with-cancer-a-population-based-study-using-health-services-data
#9
Alisha Kassam, Rinku Sutradhar, Kimberley Widger, Adam Rapoport, Jason D Pole, Katherine Nelson, Joanne Wolfe, Craig C Earle, Sumit Gupta
Purpose Children with cancer often receive high-intensity (HI) medical care at the end-of-life (EOL). Previous studies have been limited to single centers or lacked detailed clinical data. We determined predictors of and trends in HI-EOL care by linking population-based clinical and health-services databases. Methods A retrospective decedent cohort of patients with childhood cancer who died between 2000 and 2012 in Ontario, Canada, was assembled using a provincial cancer registry and linked to population-based health-care data...
January 10, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28050134/chemotherapy-in-recurrent-advanced-non-small-cell-lung-cancer-after-adjuvant-chemotherapy
#10
M Valdes, G Nicholas, G D Goss, P Wheatley-Price
INTRODUCTION: Despite adjuvant systemic therapy in patients with completely resected non-small-cell lung cancer (nsclc), many will subsequently relapse. We investigated treatment choices at relapse and assessed the effect of palliative platinum doublet systemic therapy in this population. METHODS: With research ethics board approval, we performed a retrospective chart review of all patients with resected nsclc who received adjuvant systemic therapy from January 2002 until December 2008 at our institution...
December 2016: Current Oncology
https://www.readbyqxmd.com/read/28042069/comprehensive-and-integrated-palliative-care-for-people-with-advanced-chronic-conditions-an-update-from-several-european-initiatives-and-recommendations-for-policy
#11
Xavier Gómez-Batiste, Scott Murray, Keri Thomas, Carles Blay, Kirsty Boyd, Sebastien Moine, Maxime Gignon, Bart Van den Eynden, Bert Leysen, Johan Wens, Yvonne Engels, Marianne Dees, Massimo Costantini
The number of people in their last years of life with advanced chronic conditions, palliative care needs and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer...
December 29, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28041600/study-protocol-for-the-option-randomised-controlled-trial-on-the-effect-of-prioritising-treatment-goals-among-older-patients-with-cancer-in-a-palliative-setting
#12
M E Stegmann, J Schuling, T J N Hiltermann, A K L Reyners, H Burger, M Y Berger, A J Berendsen
PURPOSE: Traditionally, general practitioners (GPs) are not involved in cancer-related treatment decisions, despite their often long relationship with patients, and their unique position to explore patients' values, especially with older patients. Therefore, we designed a randomised controlled trial to study the effect, on self-efficacy related to treatment decisions, of a conversation about treatment goals between GPs and patients with cancer in a palliative setting. METHODS: We aim to include 168 patients aged ≥70 years with a diagnosis of non-curable cancer, due to consult their oncologist about treatment options...
February 2017: Maturitas
https://www.readbyqxmd.com/read/28035750/bleeding-risk-of-terminally-ill-patients-hospitalized-in-palliative-care-units-the-rheso-study
#13
Bernard Tardy, Stéphane Picard, Frédéric Guirimand, Céline Chapelle, Marie Delerue Danel, Thomas Celarier, Jean-François Ciais, Pascale Vassal, Sébastien Salas, Marilène Filbet, Jean-Marie Gomas, Aline Guillot, Jean-Baptiste Gaultier, Adel Merah, Anne Richard, Silvy Laporte, Laurent Bertoletti
BACKGROUND: The value of primary thromboprophylaxis in patients admitted to palliative care units is debated. Moreover, the bleeding risk of these patients is unknown. OBJECTIVES: Our primary aim was to assess the bleeding risk of patients in a real-world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep-vein thrombosis and to identify risk factors for bleeding. PATIENTS/METHODS: In this prospective, observational study in 22 French palliative care units, 1199 patients (median age: 71 years, male: 45...
December 30, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28029308/effects-of-early-integrated-palliative-care-in-patients-with-lung-and-gi-cancer-a-randomized-clinical-trial
#14
Jennifer S Temel, Joseph A Greer, Areej El-Jawahri, William F Pirl, Elyse R Park, Vicki A Jackson, Anthony L Back, Mihir Kamdar, Juliet Jacobsen, Eva H Chittenden, Simone P Rinaldi, Emily R Gallagher, Justin R Eusebio, Zhigang Li, Alona Muzikansky, David P Ryan
Purpose We evaluated the impact of early integrated palliative care (PC) in patients with newly diagnosed lung and GI cancer. Patients and Methods We randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated PC and oncology care (n = 175) or usual care (n = 175) between May 2011 and July 2015. Patients who were assigned to the intervention met with a PC clinician at least once per month until death, whereas those who received usual care consulted a PC clinician upon request...
December 28, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28018110/preoperative-evaluation-of-pancreatic-ductal-adenocarcinoma-with-synchronous-liver-metastasis-diagnosis-and-assessment-of-unresectability
#15
Hao-Jun Shi, Chen Jin, De-Liang Fu
AIM: To identify predictors for synchronous liver metastasis from resectable pancreatic ductal adenocarcinoma (PDAC) and assess unresectability of synchronous liver metastasis. METHODS: Retrospective records of PDAC patients with synchronous liver metastasis who underwent simultaneous resections of primary PDAC and synchronous liver metastasis, or palliative surgical bypass, were collected from 2007 to 2015. A series of pre-operative clinical parameters, including tumor markers and inflammation-based indices, were analyzed by logistic regression to figure out predictive factors and assess unresectability of synchronous liver metastasis...
December 7, 2016: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28009643/palliative-care-and-chronic-obstructive-pulmonary-disease-where-the-lines-meet
#16
Sarah E Harrington, Elizabeth Rogers, Megan Davis
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is expected to increase as the population ages. Patients have a high symptom burden, low healthcare quality of life, and unmet needs at the end of life. This review highlights specific palliative care needs of patients with advanced COPD and opportunities to integrate palliative care into standard practice. RECENT FINDINGS: There are many barriers to providing integrated palliative care in COPD, including difficulty with prognostication, communication barriers surrounding advance care planning, and lack of access to specialty palliative care...
December 21, 2016: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28009454/direct-estimation-for-adaptive-treatment-length-policies-methods-and-application-to-evaluating-the-effect-of-delayed-peg-insertion
#17
Xin Lu, Brent A Johnson
Dysphagia is a primary cause of death among patients diagnosed with amyotrophic lateral sclerosis (ALS), and percutaneous endoscopic gastrostomy (PEG) is a procedure to insert a tube into the stomach to assist or replace oral feeding. It is believed that PEG is beneficial and, generally, earlier insertion is preferable to later. However, gathering clinical evidence to support these beliefs on the use and timing of PEG is challenging because controlled clinical trials are not feasible and clinical endpoints are confounded with PEG in observational data...
December 23, 2016: Biometrics
https://www.readbyqxmd.com/read/28008747/validation-of-an-instrument-to-measure-moral-distress-within-the-australian-residential-and-community-care-environments
#18
Adam Burston, Robert Eley, Deborah Parker, Anthony Tuckett
AIM AND OBJECTIVES: The aim of this study was to gain insight into the experience of moral distress within the aged care workforce. The objective of this study was to use and validate an existing instrument to measure moral distress within the aged care setting. BACKGROUND: Moral distress, a phenomenon associated with worker satisfaction and retention, is common within nursing. Instruments to measure moral distress exist; however, there are no validated instruments to measure moral distress within an aged care setting...
December 23, 2016: International Journal of Older People Nursing
https://www.readbyqxmd.com/read/27997278/the-appropriate-provision-of-primary-versus-specialist-palliative-care-to-cancer-patients-oncologists-perspectives
#19
Risha Gidwani, Andrea Nevedal, Manali Patel, Douglas W Blayney, Christine Timko, Kavitha Ramchandran, P Adam Kelly, Steven M Asch
BACKGROUND: Many cancer patients do not receive recommended palliative care (PC). Oncologists' perspectives about PC have not been adequately described qualitatively and may explain some of the gaps in the delivery of PC. OBJECTIVE: To characterize U.S. oncologists' perceptions of: primary and specialist PC; experiences interacting with PC specialists; and the optimal interface of PC and oncology in providing PC. DESIGN: In-depth interviews with practicing oncologists...
December 20, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27965885/evaluation-of-the-effectiveness-of-music-therapy-in-improving-the-quality-of-life-of-palliative-care-patients-a-randomised-controlled-pilot-and-feasibility-study
#20
Tracey McConnell, Lisa Graham-Wisener, Joan Regan, Miriam McKeown, Jenny Kirkwood, Naomi Hughes, Mike Clarke, Janet Leitch, Kerry McGrillen, Sam Porter
BACKGROUND: Music therapy is frequently used as a palliative therapy. In consonance with the goals of palliative care, the primary aim of music therapy is to improve people's quality of life by addressing their psychological needs and facilitating communication. To date, primarily because of a paucity of robust research, the evidence for music therapy's effectiveness on patient reported outcomes is positive but weak. This pilot and feasibility study will test procedures, outcomes and validated tools; estimate recruitment and attrition rates; and calculate the sample size required for a phase III randomised trial to evaluate the effectiveness of music therapy in improving the quality of life of palliative care patients...
2016: Pilot and Feasibility Studies
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