Hospital Palliative Care Unit Research Articles

“I couldn’t say goodbye”: Thematic analysis of interviews with bereaved relatives who lost their loved ones during the COVID-19 pandemic

BackgroundDelivering serious news is usually challenging for healthcare professionals and the pandemic of COVID-19 and related restrictions brought additional challenges in this process.AimsTo explore the experience of bereaved relatives with receiving serious news from healthcare professionals during the pandemic COVID-19.DesignA qualitative study using thematic analysis and a codebook approach of data collected in semi-structured interviews with bereaved relatives.Setting/participantsData were collected from July to August 2022 in person/via phone with bereaved relatives who lost their relatives during the pandemic (from March 2020 to March 2022). Participants were recruited using a convenience sample and snowball method through social media and through one university hospital palliative care unit that invited bereaved relatives of deceased patients treated at the unit to participate in this study.ResultsA total of 22 participants, consisting of 4 men and 18 women, were interviewed for this study. Most of the participants were sons or daughters of individuals who had died (5 grandchildren, 14 sons/daughters, 2 spouses, 1 great-niece). Six themes were identified: Burden caused by visit ban, Fear of COVID-19, Inappropriate behaviour and communication of healthcare professionals, High need for emotional support, Need for detailed and honest communication, Tendency to make excuses for mistakes and lapses by healthcare professionals.ConclusionsDelivering serious news during a pandemic was negatively influenced by a lack of contact with patients and a lack of support and empathetic communication with staff. Overcoming these circumstances can be achieved by frequent communication using various communication tools (such as videoconferences or phone calls), and maintaining empathy and honesty in the communication process.

Palliative Care for Patients With Breast Cancer in a Palliative Care Unit of a Japanese Hospital

Palliative Care for Patients With Breast Cancer in a Palliative Care Unit of a Japanese Hospital

General practitioners and palliative care practices: a better knowledge of specific services is still needed

BackgroundFrance allows deep sedation for pain relief, but not for euthanasia. In anticipation of an increase in home-based palliative care, the role of general practitioners is central to the design of outpatient palliative care services. This study aimed to describe the knowledge, attitudes, and practices of general practitioners in mainland France regarding palliative and end of life care.MethodsThis was a national descriptive cross-sectional study within the Sentinelles network. Self-report questionnaires were distributed to general practitioners between November 2020 and November 2021. A descriptive analysis was carried out.ResultsOut of the 123 participating general practitioners, 84% had received academic training in palliative care (n = 104). While a significant majority (69%) expressed comfort in pain management, only a quarter (25%) declared that they were competent at indicating deep and continuous sedation for pain relief. Awareness of outpatient palliative care facilities close to their place of practice such as hospitalization at home was over 97% (n = 117/120). Awareness of hospital facilities, including identified palliative care beds on hospital wards and palliative care units, was lower (75% (n = 59/79) and 86% (n = 86/100), respectively).ConclusionsOur results suggest that French general practitioners are reasonably aware of palliative care resources available. However, there is room for improvement, particularly in understanding hospital-based facilities. Furthermore, a quarter of the general practitioners expressed discomfort with deep and continuous sedation for pain relief, highlighting the need for increased training in this specific aspect of palliative and end of life care.

Assessment of pain control in advanced cancer patients admitted to a palliative care unit

Introduction: Pain in people with cancer is prevalent and should have an individualized therapeutic plan. Objectives: To evaluate pain control in advanced cancer patients in a hospital palliative care unit. Methods: This is a cohort study, with prospective design, and quantitative approach, including advanced cancer patients admitted to a palliative care unit between June 2021 and February 2022 reporting pain. Data was collected from medical records and the Brief Pain Inventory (BPI) was used to assess pain on the first (D1), third (D3) and seventh (D7) day of hospitalization. Results: One hundred and four patients participated in the study. The most prevalent tumors were of the gastrointestinal tract (n=23; 22%), cervix (n=21; 20%) and breast (n=17; 16%). Abdomen was the most reported site of pain (n=34; 33%), with 50% classified as nociceptive pain, 39% neuropathic pain, and 11% mixed. On D1, 43% reported severe pain, 31% moderate, and 12% mild pain. There was an evolutionary drop in the percentage of severe pain (BPI3 70% to 37.1%; BPI4 12.6% to 5.4%; BPI5 42.5% to 13.5%; and BPI9 67.8% to 21.6%) according to the answers to all BPI questions during the period. On D1, D3 and D7, the average equipotent doses of oral morphine were 116 mg, 133 mg and 154 mg and the frequency of use of adjuvant use was 60%, 75%, and 69%, respectively. Conclusions: Pain was properly controlled and was related to the increased use of adjuvants, both for general and neuropathic pain. It was possible to observe that the use of adjuvants was related to better pain control.

Adding spontaneity to organizations – what hospice volunteers contribute to everyday life in German inpatient hospice and palliative care units: a qualitative study

BackgroundVolunteers have always been integral to hospice and palliative care. However, their roles have been left relatively undefined and broad.AimThis study aims to examine the role of hospice volunteers in German inpatient hospice and palliative care. The question we seek to answer is: What do hospice volunteers contribute to everyday life in inpatient hospice and palliative care units?MethodsWe undertook a multicenter, on-site qualitative interview study, utilizing problem-centered interviews with 16 volunteers from five inpatient hospice units and one hospital palliative care unit. Interviews were analyzed using grounded theory.ResultsAnalysis of the interviews revealed three typical characteristics of how hospice volunteers’ describe their own role: (1) performing small acts of kindness, (2) creating a family-like atmosphere, (3) expecting emotional experiences. A common theme across all categories is the emphasis on spontaneous actions and personal experiences. The process of dying becomes an experience interpreted by volunteers as enriching, as a gift, as a “teacher”.ConclusionGranting hospice volunteers freedom to act spontaneously and intuitively benefits hospice and palliative care delivery. Organizations should leave sufficient room for spontaneity in order to involve volunteers effectively. Open and unstandardized roles facilitate dynamic work practices.

The effect of mindfulness-based compassionate living training for informal caregivers of palliative inpatients on burnout and caregiving burden: a randomized controlled trial.

This study was conducted to determine the effect of Mindfulness-Based Compassionate Living (MBCL) training given to the informal caregivers of palliative patients on burnout and caregiving burden. A single-blind, randomized, controlled, experimental study was conducted with 54 caregivers of patients admitted to a hospital palliative care unit. The participants were randomly allocated to the experimental group (n = 26) and control group (n = 28). The experimental group received MBCL training twice a week for 4 weeks. Data were collected before and after the intervention using the Maslach Burnout Inventory, Caregiver Burden Scale and Self-Compassion Scale-Short Form. The data were analyzed using kurtosis and skewness coefficients, number, percentage, mean, standard deviation, chi-square test, independent samples t test, Wilcoxon signed ranks test and Mann-Whitney U test in SPSS version 22.0. The informal caregivers in the experimental group demonstrated a significant decrease in emotional exhaustion and depersonalization scores and an increase in personal accomplishment and self-compassion scores in posttest assessments after the MBCL intervention (P < 0.05). All of these parameters differed significantly between the experimental and control groups after the intervention (P < 0.05). MBCL training seems to be effective in reducing emotional exhaustion and depersonalization and increasing personal accomplishment and self-compassion among informal caregivers of palliative inpatients. The results of this study can be generalized to the caretakers of patients receiving palliative care in university hospitals.

Can neutrophil-lymphocyte ratio and mean platelet volume be used to predict metastasis in individuals with lung cancer?

Chronic inflammation plays an important role in the etiopathogenesis of many life-threatening chronic diseases, including cancer. Currently, the relationship between inflammation, native immunity and cancer is widely accepted; however, many of the mechanisms mediating this relationship remain undetermined and the clinical significance of these markers is unclear. The purpose of this study was to investigate the potential of neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) to indicate the existence of metastasis in lung cancer. This retrospective cross-sectional study evaluated patients with lung cancer of any pathological type who was admitted to the Palliative Care Unit of the referral hospital in the region between January 2019 and February 2020. Patient characteristics, distant organ metastasis, treatments, NLR and MPV values were noted. Patients were grouped as with or without metastasis. Characters, NLR, MPV values were compared. One hundred twenty-six patients were included. The mean age of the patients was 61.17 ± 9.4 years and 7.9% (n = 10) were female. The patients with a history of chemotherapy were 47% (n = 60) and distant organ metastases were present in 38.9% (n = 49) of the patients. The mean MPV value of 49 patients with distant metastasis was 8.34 ± 0.8 fL. MPV values of those with metastasis were found to be significantly higher than those without (P = .010). There was no significant difference in NLR values between groups (P = .920). Lung cancer patients with metastasis were found with higher MPV values. MPV can be effective and most accessible test in prediction of metastasis in lung cancer patients regardless of the pathological type.

Plasma Interleukin-6 Levels in Relation to the Severity of Pain in Cancer Patients: A Case-control Study from a Tertiary Care Centre in North East India

Introduction: With increased levels of ferritin, C-Reactive Protein (CRP), and the proinflammatory cytokine Intrleukin-6 (IL-6) frequently seen in cancer patients, inflammation is acknowledged as a critical component in the context of cancer. For medical professionals, managing pain in cancer patients, whether from the illness or its treatment, remains a constant struggle. Aim: To compare the markers of inflammation between controls and cancer patients with pain and to correlate the degree of pain and IL-6 levels in this group of patients. Materials and Methods: The present case-control study was conducted from January 2022 to December 2022 on 45 age-matched controls and 40 cancer patients with varied levels of pain who were included in the Palliative Care Unit of a State Cancer Hospital, Guwahati, Assam, India. The intensity of pain was measured using a Numerical Rating Scale (NRS). Blood samples were taken to assess the levels of IL-6, ferritin, and CRP. The data were analysed statistically using one-way Analysis of Variance (ANOVA) and linear regression, and were presented as mean±Standard Deviation (SD). Results: Compared to controls, cancer patients had significantly higher levels of IL-6, CRP, and ferritin (p-value &lt;0.001). Spearman’s correlation analysis revealed a positive link between pain intensity and IL-6 (p-value&lt;0.001, r-value=0.516) and between pain and CRP (p-value=0.002, r-value=0.474) was found using Spearman’s correlation analysis. Conclusion: The study results suggest a possible role for IL-6 in cancer-related pain by indicating a clear correlation between elevated IL-6 levels and the severity of pain experienced by cancer patients. This lays the foundation for investigating IL-6 antagonists as potential painkillers for cancer patients.

A Phenomenological Investigation Into the Meaning of Food in Palliative Care Patients With Anorexia.

Little has been published on the meaning of food to palliative care patients with anorexia. Our study aims to investigate the meaning of food in palliative patients with anorexia. Fifteen patients with anorexia were recruited from the Palliative Care Unit of an acute hospital in Singapore from August 2018 to August 2021. A phenomenological methodology was employed to study the lived experience of anorexia and the meaning of food to palliative care patients. Our study findings revealed that food has social, physical, and emotional meaning in palliative care patients with anorexia. The social meaning of food was the predominant theme. Food was viewed as an important tool to bond and connect with their loved ones. It was perceived to be more important than the food itself and the taste of food was enhanced through social interactions. Food intake was related to physical strength and health status. Patients regarded eating as a way to improve their health status. Emotionally, eating was associated with positive feelings like enjoyment and freedom. Half of our participants felt that anorexia contributed to their low mood. Therefore, unlike the traditional focus of modifying the taste and quality of food in patients with anorexia, the authors recommended a focused assessment and management of the social aspect of anorexia on individual. This is important to mitigate the negative impact of anorexia, thus improving the quality of life and increasing their dignity towards the end of their lives.

Validation of the Spanish Versions of FACIT-PAL and FACIT-PAL-14 in Palliative Patients.

Palliative patients require several types of care to improve their quality of life as much as possible, and valid and reliable assessment instruments are essential. The objective of this study is the Spanish validation of the Functional Assessment Chronic Illness Therapy-Palliative Care (FACIT-PAL) and its abbreviated version, FACIT-PAL-14, in palliative care patients. FACIT-PAL and FACIT-PAL-14 were translated into Spanish and administered to 131 terminal oncology patients in home palliative care units, hospital palliative care units, health center teams, and social health centers. The European Organization for Research and Treatment of Cancer questionnaire, EORTC-QLQ-C15-PAL version, was used to evaluate the criterion validity. The EORTC-QLQ-C15-PAL was employed as a “gold standard”, and it obtained significant results with FACIT scales. FACIT-PAL-14, FACIT-PAL, and its subscales reported high internal consistency, from 0.640 to 0.816. The exploratory factor analysis for FACIT-PAL-14 found a structure in three factors that explained the 70.10% variance, and the FACIT-PAL scale found a structure of five factors. Physical wellbeing from FACIT-PAL highly correlated to the EORTC-QLQ-C15-PAL (r = 0.700), but social and family wellbeing was correlated to a lesser extent (r = −0.323). FACIT-PAL and the TOI (Toi Outcome Index) were also highly correlated with the EORTC-QLQ-C15-PAL, with values of r = −0.708 and r = −0.709, respectively. The Spanish versions of FACIT-PAL and FACIT-PAL-14 were demonstrated to be valid and reliable scales in palliative care patients.

Consultations’ demand for a hospital palliative care unit: how to increase appropriateness? Implementing and evaluating a multicomponent educational intervention aimed at increase palliative care complexity perception skill

BackgroundPlanned, multidisciplinary teams’ discussions of cases are common in cancer care, but their impact on patients’ outcome is not always clear. Palliative care (PC) needs might emerge long before the last weeks of life. Many palliative care patients could be managed from the usual care staff, if appropriately trained; specialist palliative care should be provided to patients with more complex needs. Staff needs adequate training, so that only patients presenting a higher complexity are properly referred to the second level (“specialized”) PC services. In the considered hospital setting, “tumour boards” (multidisciplinary discussions) refer often to a low number of patients. Overall complexity of patients’ needs is hardly considered.MethodsA mixed method pilot study with data triangulation of professionals’ interviews and an independently structured evaluation of complexity of referred patients, before and after the intervention, using the PALCOM instrument. We trained four teams of professionals to deliver first-level palliation and to refer patients with complex needs detected in multidisciplinary discussions. A multicomponent, first level PC educational intervention, including information technology’s adaptation, a training course, and bedside training was offered from the specialized PC Services, to all the HPs involved in multidisciplinary pancreas, lung, ovarian, and liver tumour boards.ResultsWhile the level of complexity of referred patients did not increase, trainees seemed to develop a better understanding of palliative care and a higher sensitivity to palliative needs. The number of referred patients increased, but patients’ complexity did not. Qualitative data showed that professionals seemed to be more aware of the complexity of PC needs. A “meaning shift” was perceived, specifically on the referral process (e.g., “when” and “for what” referring to specialist PC) and on the teams’ increased focus on patients’ needs. The training, positively received, was adapted to trainees’ needs and observations that led also to organizational modifications.ConclusionsOur multicomponent intervention positively impacted the number of referrals but not the patients’ complexity (measured with the PALCOM instrument). Hospital staff does not easily recognize that patients may have PC needs significantly earlier than at the end of life.

The role of geriatricians in hospital palliative care units for elderly patients affected by end stage diseases.

To show the importance of geriatricians in the assessment and treatment of patients with terminal illnesses requiring palliative care. This was a retrospective epidemiological study, in which the authors used data relating to 229 patients with terminal stage cancer/advanced chronic diseases, which were evaluated by a palliative care team and collected from January to December 2018. The average age of the sample was 72 years. The sample was divided into two groups, called 'advanced cancer' (N=161, 70.3%) and 'advanced chronic diseases' (N=68, 29.6%). The authors found that patients with advanced chronic diseases had the highest age, highest number of comorbidities and higher indicators of complex care. The authors also showed that, in advanced chronic diseases, the factors that are associated with increased hospital death are: bedridden (OR=3,778; 95% CI=1,371-10,409), dysphagia (OR=2,038; 95% CI=1,005-4,133) and a higher number of diseases (OR=1,446; 95% CI=1,179-1,774). Given these findings, there is a high prevalence of elderly hospitalised patients with advanced chronic end-stage disease, a classic geriatric condition, who need access to palliative care services. The authors believe that an increase in geriatricians dedicated to palliative care services is needed to ensure that these patients have equal access to continuity of care services and optimal treatment.

The effects of ketamine on pain control in stage IV cancer patients receiving palliative care

Background: We evaluated the effects of intravenous ketamine on cancer pain in stage IV cancer patients receiving palliative care.Methods: In total, 253 stage IV cancer patients with cancer pain hospitalized at a single tertiary hospital palliative care unit were included. The ketamine group contained 112 patients receiving ketamine, and the control group comprised 141 non-ketamine users. To evaluate the odds ratios (ORs) for favorable pain control, optimal pain control, and opioid-sparing effect among ketamine users, we used multivariable logistic regression adjusted for age and objective prognosis score. Differences in the visual analog scale (VAS) score, oral morphine equivalents, inter-dose frequency, and inter-dose amount were compared between both groups at the time of ketamine introduction (T0), after 24 hours (T1), and after 48 hours (T2) using repeated-measures analysis of covariance.Results: The ketamine group was more likely to show favorable pain control (OR, 3.84; 95% confidence interval [CI], 1.76–8.37) and an optimal response (OR, 3.99; 95% CI, 1.73–9.22) than the control group. Compared to the control group, the ketamine group showed a higher VAS score at T0, but a more evident VAS score reduction at T1 and T2 (pint&lt;0.001). The ketamine group was less likely than the control group to experience depressive mood (OR, 0.31; 95% CI, 0.10–0.92), but had a higher risk of delirium (OR, 2.06; 95% CI, 1.12–3.91).Conclusion: Our findings suggest that ketamine can effectively reduce refractory cancer pain in stage IV cancer patients.

Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

BackgroundDignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure.The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care.MethodThis is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed.The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively.ResultsA total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers.ConclusionsOur findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice.Trial registrationRetrospectively registered on ClinicalTrial.gov NCT04738305.

A Clinical and Cost Comparison of Cancer and Non-Cancer Patients in Palliative Care

Objective: As in many parts of the world, palliative healthcare systems were initially established for the care of cancer patients, but expanded in time to cover other patients, as well. The aim of this study was to compare cancer and non-cancer patients receiving palliative care in the city of Canakkale, Turkey, in terms of their clinical and demographic data, treatment times, and costs. Method: All patients hospitalized in Canakkale State Hospital Palliative Care Unit between December 01, 2016 and December 01, 2017 were included in our study. Their demographic data, diagnoses, lengths of stay, mortality rates, and treatment costs were recorded retrospectively. Results: The study included a total of 415 patients, of which 187 (45.1%) were female. Mean age was 76.54 and the range of distribution was 24-100. Mortality developed in 162 (39%) of all patients and 253 (61%) were discharged. A comparison of cancer and non-cancer patients showed that mean age of the former group was significantly lower. Hospital stay and treatment costs of patients hospitalized for diseases other than cancer were found to be significantly higher than those of cancer patients. Conclusions: Palliative care is an approach that improves the quality of life of patients and their families. As the costs of healthcare in intensive care units kept increasing, palliative care centers started to spread worldwide. Palliative care service includes cancer patients as well as those suffering from chronic neurological diseases and geriatric patients. Palliative care services are expected to increase and expand gradually as the average life increases. Therefore, it deserves better attention as a discipline.

Learning a palliative care approach during the COVID-19 pandemic: A case study in an Infectious Diseases Unit

Background: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. Aim: The aim of the study was to describe a palliative care unit’s consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. Design: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. Setting/participants: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. Results: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study. Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. Conclusion: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients’ use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.

Art Therapy in a Palliative Care Unit: Symptom Relief and Perceived Helpfulness in Patients and Their Relatives

ContextCreative arts therapies aim to expand conventional palliative care interventions by making clinical care more holistic. ObjectivesThe objective of the present study was to evaluate the benefits of an art therapy intervention in a tertiary hospital palliative care unit, directly in adult cancer inpatients and indirectly in their relatives. MethodsWe evaluated the intensity of pain, anxiety, depression, and well-being using the Edmonton Symptom Assessment Scale before and after the first, third, and fifth art therapy sessions. After the third and fifth sessions, perceived helpfulness was assessed via a questionnaire developed by the palliative care team, combining open-ended questions and a checklist. We categorized the narrative data into three predetermined types: generally helpful (some positive experience), helpfulness related to a dyadic relationship (patient-art therapist), and helpfulness related to a triadic relationship (patient-image-art therapist). ResultsWe observed a significant reduction in anxiety, depression, and pain as well as a significant increase in well-being at each of the time points evaluated. Ninety-eight percent of the patients considered the art therapy helpful, which could be categorized as generally helpful in 54.8%, related to a triadic relationship in 32.9%, and to a dyadic relationship in 12.3%. Relatives gave similar opinions regarding the effects on patients and, in addition, reported an indirect helpful effect for themselves. The most frequently selected experiences from the checklist were feeling calm, being entertained, and expressing and communicating emotions. ConclusionThis art therapy intervention was beneficial in reducing symptom intensity. Almost all the participants directly or indirectly involved in the creative art process considered it helpful. They reported a wide variety of sensory, emotional, cognitive, and spiritual experiences.

A screening method for sleep disturbances at the end-of-life.

To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit. The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question "How much do you worry about your sleep problems?" which is answered on a scale of 0-10 (Sleep-Worry-Q) and another single question: "Do you think you have sleep problems?" with two response categories, Yes/No (Sleep-Problem-Q). According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65. Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.

SUPPORTIVE CARE IN HEART FAILURE: ESTABLISHING A NEW INTEGRATIVE CARE INITIATIVE

Supportive care (SC) is an under-utilized resource for heart failure (HF) patients. Given the symptom burden experienced by HF patients, they would greatly benefit from SC. However, there is a big gap between demand and services when it comes to SC for HF patients. The most challenging barrier to integrating SC in HF patient care is patient screening. Various screening tools were evaluated for their predictive value, and a summary score < 29 on the Kansas City Cardiomyopathy Questionnaire (KCCQ) was the strongest predictor of subsequent SC need. HF patients with SC needs were identified using a KCCQ summary score < 29 as the cut-off. Patient demographic and baseline clinical characteristics including medical history, discharge medication, laboratory results and echocardiography parameters were compared between patients with and without SC needs. Patients with SC needs were referred to and followed up at our SC clinic (SCC). Outcomes in terms of home care access, goals of care (GOC) changes, implantable cardioverter defibrillator (ICD) deactivation and hospitalization at end-of-life were measured for those referred to SC services. SC needs was identified in 41 patients (9%), among 456 who completed the KCCQ. Demographics were similar between the two groups of patients, except patients with SC needs have significantly higher BMIs and have more severe NYHA classes. Mineralocorticoid receptor antagonists (MRAs) were used more frequently in patients without SC needs. Of those with SC needs, 22 were referred to SC services: 2 passed away before being seen, 1 refused SC and 19 were seen at the SCC. Of these 19, 10 passed away and 9 are currently followed. All patients were referred to home care, and 53% changed their GOC to care focused on symptom control and comfort. One patient had their ICD deactivated. The median number of emergency department visit/hospitalization post-SC consultation is 1 (IQR: 0-2). Median survival after SC initiation is 3 months, with patients spending less than a month to 11 months before passing away. Of the 10 patients that passed away, 2 passed away at the emergency department, 1 at the internal medicine unit, 4 at home and 3 at hospital palliative care units. There is clearly an unmet need for SC among HF patients. A KCCQ summary score < 29 is useful for identifying patients with SC needs in routine clinical practice. Incorporating SC into cardiac care for HF patients is essential to improve their quality of life.

Complicações da via subcutânea na infusão de medicamentos e soluções em cuidados paliativos

Objetivo: caracterizar as complicações associadas ao uso da via subcutânea na infusão de medicamentos e soluções em cuidados paliativos. Métodos: estudo observacional, prospectivo, realizado na Unidade de Cuidados Paliativos de um hospital geral de ensino. Resultados: foram avaliados 78 pacientes em cuidados paliativos, nos quais foram realizadas 254 punções na via subcutânea para infusão de medicamentos e/ou soluções. A maioria era idosa (87,3%) e encontrava-se desnutrida (69,2%). Em 33,0%, a via foi indicada para controle de sintomas e, em 50,0%, a punção ocorreu na região anterolateral da coxa; 65,4% das punções não mostraram complicação. Dentre as complicações identificadas, 9,4% foram edema e 9,1% hiperemia, sendo que 53,8% delas ocorreram na região deltoidea. A celulite ocorreu em apenas 3,5%. Conclusão: a infusão de soluções pode ser considerada uma alternativa segura, a qual apresenta risco de complicações em sua maioria facilmente reversíveis e com baixo potencial de ocasionar danos aos pacientes.