Palliative Care Patients Research Articles

272. HOSPITAL VARIATION IN PALLIATIVE TREATMENT FOR ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CANCER: A NATIONWIDE POPULATION-BASED STUDY IN THE NETHERLANDS

Abstract Background Palliative care for patients with esophageal (EC) includes a large variety of treatments and data on variation of palliative care across centers are unknown. This study aims to evaluate treatment variation at the hospital level for EC and GC patients in the Netherlands. Methods A nationwide retrospective cohort study was conducted using population-based data from the Netherlands Cancer Registry. Patients diagnosed with inoperable advanced (cT4B) or synchronous metastatic (cM1) EC between 2015-2022 were included. Probability of receiving potentially life-prolonging treatment (palliative resection, chemoradiotherapy or systemic treatment) according to hospital of diagnosis was analyzed using multilevel logistic regression analysis. Hospitals were categorized in tertiles according to this probability (high, medium, low) and overall survival (OS) was assessed using cox regression analysis. Results 8,580 EC patients were included. Potentially life-prolonging treatment ranged from 23.5%-74.0% across hospitals of diagnosis (p<0.0001). After adjustment for patient and tumor characteristics, the probability of receiving these treatments was associated with hospital of diagnosis (p<0.0001). 13 of 79 hospitals demonstrated a significantly lower probability of giving potentially life-prolonging treatment. Patients diagnosed in hospitals with low probability of potentially life-prolonging treatment with had significantly worse OS than medium- (HR 0.85 (0.80-0.90) p<0.0001) or high-probability hospitals (HR 0.77 (0.73-0.82) p<0.0001). Conclusion This study shows substantial variation in palliative treatment for EC and GC care across Dutch hospitals, emphasizing the challenge of defining optimal treatment plans. Hospital of diagnosis was significantly associated with the probability of receiving potentially life-prolonging treatment and also with overall survival. These results suggest that appropriate selection of patients for treatment with potentially life-prolonging treatment leads to improved OS.

1887P Effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients

1887P Effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients

ESTUDO DE EMERGÊNCIAS ONCOLÓGICAS EM PACIENTES PEDIÁTRICOS: REVISÃO OBSERVATÓRIA

Care activities in intensive care units and for cancer patients are guided by the humanization of care and contribute to hospital management, seen as a challenge to be faced in order to promote advances in the implementation of health policy in Brazil. In this way, it is feasible to analyze in this study a reflection on the humanization of care provided to critically ill patients, the strategies of humanization and care in the ICU and in patients under palliative care, in order to identify improvements in the care of critically ill patients in a humanized way. The aim of this study is to identify, through literature reviews, the interventions of nursing professionals in assisting patients in palliative care in the area of pediatric oncology. The methodology used is bibliographical research, based on articles available on the internet. In Brazil, a number of problems persist in health institutions on a daily basis, which are rooted in the system and make it difficult to achieve the principles of universality, comprehensiveness and equity, which are fundamental to the Unified Health System (SUS). To work in the Oncology Unit and provide palliative care. Thus, health professionals must have specialized and qualified training, including experience acquired throughout their careers, as well as personal and professional development.

Expectation, emotion and the built environment: experiences of occupying hospital spaces as a loved one nears the end of life

Following a 3-year long research project that gathered 146 views, including those of palliative care patients, family members, medical staff, administrators, architects and government representatives, this paper explores the hypothesis...

Focus on the Role of Non-Invasive Respiratory Support (NRS) during Palliative Care in Patients with Life-Limiting Respiratory Disease.

The management of patients with life-threatening respiratory disease in the ICU and at home has become increasingly of interest over the past decades. Growing knowledge supports the use of NRS, aimed at improving patient comfort and improving quality of life. However, its role during palliative care is not well defined, and evidence of support remains limited. The aim of this narrative review is to examine the recent evidence relating to the use of non-invasive respiratory support at the end of life, in order to clarify who benefits and when. The literature research was conducted on PubMed, using MeSH words. A review of the relevant literature showed that non-invasive respiratory support techniques for patients with life-limiting respiratory disease vary (from high-flow oxygen therapy to conventional oxygen therapy, from CPAP to NPPV) and each has precise indications. To date, from the hospital to the home setting, the monitoring and application of these respiratory support techniques have varied widely. In conclusion, the choice of respiratory support in this category of patients should be based on the technique that will optimize the comfort of the patient and improve the quality of their life. On the other hand, regarding monitoring, both telemedicine and ultrasound diagnostics help to satisfy the patient's wish to spend the last period of his life in the home environment, to avoid inappropriately aggressive diagnostic interventions, and to reduce the high costs of hospitalized procedures in this category of patients.

570: Shorter irradiation time for palliative care patients treated with VMAT for spinal metastases.

570: Shorter irradiation time for palliative care patients treated with VMAT for spinal metastases.

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

Background This study describes the end-of-life care management in palliative care units (PCUs) for patients with breast cancer in Japan. Methods The medical data of patients admitted to the palliative care unit of Kashiwara Municipal Hospital between October 2017 and December 2023 were analyzed. A chi-square test was conducted to analyze the data using the Excel software (Microsoft Corp., Redmond, WA). Results The most common clinical condition among the 32 patients with breast cancer in our palliative care unit was pleural effusion (17/32, 53.1%), followed by obstructive jaundice (6/32, 18.8%), disseminated intravascular coagulation (DIC) (4/32, 12.5%), and hypercalcemia (1/32, 3.1%). Most patients had no indications for pleural effusion removal, biliary drainage, or anticoagulation therapy. Palliative sedation was performed in 25% of the patients with breast cancer, mainly to relieve intolerable general fatigue. There were no statistically significant differences in the sedation ratios between breast cancer and cancers at other primary sites. Conclusion Palliative treatments using appropriate infusion, narcotics, oxygen administration, various drugs, and sedation were administered in our palliative care unit to relieve symptoms instead of radical treatments for severe clinical conditions of breast cancer.

Palliative care screening tools and patient outcomes: a systematic review

BackgroundPalliative care (PC) refers to providing patients with physical, psychological, mental, and other care and humanistic care services in a multidisciplinary collaborative mode with end-of-stage patients and family members as...

Patients near death receiving specialized palliative home care being transferred to inpatient care – a registry study

BackgroundThe majority of palliative care patients express a preference for remaining at home for as long as possible. Despite progression of disease there is a strong desire to die at home. Nonetheless, there are transfers between care settings, demonstrating a discrepancy between desired and actual place of death.AimTo map the prevalence of patients near death undergoing specialized palliative home care and being transferred to inpatient care in Sweden.MethodsA national retrospective cross-sectional study based on data from the Swedish Register of Palliative Care. Patients ≥ 18 years of age enrolled in specialized palliative home care with dates of death between 1 November 2015 and 31 October 2022 were included (n = 39,698). Descriptive statistics were used.ResultsSeven thousand three hundred eighty-three patients (18.6%), approximately 1,000 per year, were transferred to inpatient care and died within seven days of arrival. A considerable proportion of these patients died within two days after admission. The majority (73.6%) were admitted to specialized palliative inpatient care units, 22.9% to non-specialized palliative inpatient care units and 3.5% to additional care units. Transferred patients had more frequent dyspnoea (30.9% vs. 23.2%, p < 0.001), anxiety (60.2% vs. 56.5%, p < 0.001) and presence of several simultaneous symptoms was significantly more common (27.0% vs. 24.8%, p 0.001).ConclusionThe results show that patients admitted to specialized palliative home care in Sweden are being transferred to inpatient care near death. A notable proportion of these patients dies within two days of admission. Common features, such as symptoms and symptom burden, can be observed in the patients transferred. The study highlights a phenomenon that may be experienced by patients, relatives and healthcare personnel as a significant event in a vulnerable situation. A deeper understanding of the underlying causes of these transfers is required to ascertain whether they are compatible with good palliative care and a dignified death.

Veterans' use of inpatient and outpatient palliative care: The national landscape.

Palliative care improves the quality of life for people with life-limiting conditions, which are common among older adults. Despite the Veterans Health Administration (VA) outpatient palliative care expansion, most research has focused on inpatient palliative care. This study aimed to compare veteran characteristics and hospice use for palliative care users across care settings (inpatient vs. outpatient) and dose (number of palliative care encounters). This national cohort included veterans with any VA palliative care encounters from 2014 through 2017. We used VA and Medicare administrative data (2010-2017) to describe veteran demographics, socioeconomic status, life-limiting conditions, frailty, and palliative care utilization. Specialty palliative care encounters were identified using clinic stop codes (353, 351) and current procedural terminology codes (99241-99245). Of 120,249 unique veterans with specialty palliative care over 4 years, 67.8% had palliative care only in the inpatient setting (n = 81,523) and 32.2% had at least one palliative care encounter in the outpatient setting (n = 38,726), with or without an inpatient palliative care encounter. Outpatient versus inpatient palliative care users were more likely to have cancer and less likely to have high frailty, but sociodemographic factors including rurality and housing instability were similar. Duration of hospice use was similar between inpatient (median = 37 days; IQR = 11, 112) and outpatient (median = 44 days; IQR = 14, 118) palliative care users, and shorter among those with only one palliative care encounter (median = 18 days; IQR = 5, 64). This national evaluation provides novel insights into the care setting and dose of VA specialty palliative care for veterans. Among veterans with palliative care use, one-third received at least some palliative care in the outpatient care setting. Differences between veterans with inpatient and outpatient use motivate the need for further research to understand how care settings and number of palliative care encounters impact outcomes for veterans and older adults.

Prevalence of oral diseases in patients under palliative care: a systematic review and meta-analysis.

Oral alterations are frequently observed in patients undergoing palliative care and are linked to the direct or indirect effects of the primary medical condition, comorbidities and medical management, leading to oral pain, impacting oral intake, and affecting quality of life. This systematic review aims to assess the prevalence of oral disease in palliative care patients. The protocol was registered at the PROSPERO database, and a systematic review of the literature was performed based on the PRISMA statement. A thorough evaluation of studies from five databases and gray literature was conducted. The risk of bias in each study was assessed using the Joanna Briggs Institute checklist for cross-sectional and case-control studies. A quantitative analysis was conducted on five studies using meta-analysis, and the degree of certainty in the evidence was determined using the GRADE tool. The sample consisted of 2,502 patients, with a slight male predominance (50.43%). The average age was 66.92years. The prevalence of oral diseases among palliative care patients was as follows: caries 32% (95% CI, 0.11-0.56; I2 = 93%), and oral candidiasis 17% (95% CI,0.11-0.25; I2 = 74%). Gingivitis and stomatitis were also reported, but with less frequency. Dental intervention should take place as early as possible, ideally from the time of the patient's initial admission to palliative care, with regular monitoring of oral health. This approach can enhance the patient's comfort and quality of life and help prevent more severe complications in the future.

Pharmacological interventions for pruritus in adult palliative care patients.

Pharmacological interventions for pruritus in adult palliative care patients.

Experiences and barriers in downward referral decision-making for palliative care patient caregivers under China's three-tiered linkage model: A qualitative study

ObjectiveThis study aimed to explore hospice caregivers’ downward referral decision-making experiences and barriers under the triadic linkage model in China and to analyze the deeper social dynamics of hospice referral choices. MethodsSemi-structured interviews were conducted with caregivers handling hospice referrals from two primary hospice agencies in Nanjing, China. The themes were analyzed and summarized using the Colaizzi 7-step analysis. ResultsFour themes and nine subthemes were extracted: multidimensional caregiver psychological experience (Dilemma and Guilt, Emotional Support and Psychological Adaptation), perceived disparities between referral organizations (convenience and affordability in the home community, perceived lack of primary health care resources), limitations of caregiver decision-making (cognitive comprehension bias, difficulty in information seeking, and passive acceptance of decision making), and limitations of health care referral support (lack of health care referral guidance, inadequate referral handoffs). ConclusionsFeedback from caregivers of hospice-referred patients reveals many barriers to hospice referral decision making and referral implementation. Overcoming these barriers entails efforts to change the cognitive misunderstandings regarding hospice referrals from patients' perspective, clarify the distribution of responsibilities among hospice agencies, and provide information support and decision-making assistance. These measures must be employed to improve the implementation of hospice referral, realize the multiple benefits of hierarchical diagnosis and treatment, boost patients’ satisfaction with the referrals, and ensure the rational and efficient distribution of hospice resources.

Prescribed medications for alleviating suffering symptoms in patients receiving palliative care at a tertiary care hospital.

Recognizing and appropriately treating symptoms of suffering in patients receiving palliative care is a means to enhance the quality of life for both the patient and their family. The objective of this study was to determine the proportion of pharmacological treatments for symptoms of suffering and prescribing patterns in hospitalized patients receiving palliative care at a tertiary care government general hospital. This retrospective study was conducted at the Prachuapkhirikhan Hospital, Thailand. All patients over 18 years old who were admitted to the hospital and received palliative care were included. Data were collected from medical charts and analyzed using descriptive statistics. During the 3-year period of study, 296 admissions were included. Cancer, cardiovascular disease, and infectious disease were the top three primary diseases for which patients received palliative care. Dyspnea was the most reported symptom of suffering (81.08%), followed by fatigue, constipation, and pain (41.89%, 35.14%, and 25.34%, respectively). All cases experienced fatigue, depression, insomnia, and anxiety received pharmacological treatment. Dyspnea, pain, nausea/vomiting, delirium, and malignant bowel obstruction were treated in at least 80% of the cases experiencing suffering. Constipation, diarrhea, and anorexia/ cachexia were treated in approximately 66.35%, 78.57%, and 67.86% of the cases, respectively. Strong opioids were the most commonly used medication for the treatment of dyspnea or pain. Our study revealed that suffering symptoms were routinely identified in hospitalized palliative care patients. Pharmacological treatments were prescribed to manage most of these symptoms. However, there is a need to improve the quality of assessing suffering symptoms severity to enhance their effectiveness.

The impact of a student death doula service-learning experience in palliative care settings on nursing students: A pilot mixed-methods study

Through a mixed-methods approach (randomized controlled trial and thematic analysis of pre and post-service-learning reflections), this study evaluated the impact of a student death doula service-learning experience on nursing students’ palliative competencies and learning experiences. The intervention group underwent a 2-day student death doula training workshop followed by a 6-month service-learning experience, while the control group received standard palliative care education. Attitudes toward the care of the dying significantly improved for the intervention group but not for compassion competence and palliative care knowledge. Six themes were developed: (1) Motivations for being a student death doula, (2) Improved perceptions of palliative care patients, (3) Perceptions of a good death, (4) Confidence in caring for palliative care patients, (5) Understanding the multifaceted nature of palliative care, and (6) Joys and challenges during service-learning. Service-learning helped students to understand palliative care patients and acquire confidence in engaging with them.

Impact of a comprehensive geriatric assessment to manage elderly patients with locally advanced non-small-cell lung cancers: a multicenter prospective study.

Concurrent chemoradiotherapy (cCRT) is the standard treatment for locally advanced and unresectable non-small-cell lung cancer. Population is aging, and Geriatric assessment (GA) has demonstrated its paper to select fit patients for active treatment and vulnerable, frail patients for interventions and/or palliative care in many histologies. Its role in locally advanced, unresectable non-small-cell lung cancer has been less explored. To assess the capability of GA to detect frail patients not suitable for active treatment, we developed this exploratory non-interventional prospective study. All patients ≥ 70years diagnosed with stage locally advanced and unresectable non-small-cell lung cancer were invited to undergo geriatric assessment. Secondary aims were description of population, exploring GA as prognostic factor, determination of toxicity profile and look for a frailty biomarker. From June 2017 to June 2020, 51 patients were included, of whom 35% (n:18) were classified as frail. Frail patients had less overall survival and more grade 3-4 toxicity. Exploratory results for frailty phenotype are described in the text. With the results of our study, we confirm that GA can detect frail patients unsuitable for treatment, with a higher risk of toxicity and less overall survival. A trend toward blood-test results for phenotype frailty can be hypothesis generation.

Exploring Environmental Considerations for Terminally Ill Pediatric Patients in Palliative Care Inpatient Units: A Narrative Review.

Background: The end-of-life experience is significantly influenced by the surrounding environment, emphasizing the importance of exploring built environmental factors in palliative care, especially for pediatric patients. As the majority of end-of-life individuals are elderly or adults, most studies have focused on the environment for this demographic. However, it is essential to recognize that children and adolescents may have distinct needs in this regard. Aim: This narrative review aims to explore the impact of the built environment on pediatric end-of-life patients in inpatient units within palliative care settings. Method: A comprehensive search was conducted across four key databases (PubMed, MEDLINE, PsycINFO, and CINAHL) to identify relevant articles. The screening process commenced with an initial assessment of article titles and abstracts, followed by a thorough examination of full-text studies that met the inclusion criteria. Data synthesis involved thematic analysis facilitated by NVIVO software and informed by the findings extracted from selected literature. Results: The review identified 22 studies meeting inclusion criteria, revealing key insights into environmental considerations in pediatric palliative care. Four themes emerged, highlighting the significance of activities and play environments, accommodation spaces for patients, supportive spaces for families, and outdoor and green spaces. Conclusions: Acknowledging limited research on architectural aspects and reliance on family and staff perspectives, future studies should prioritize understanding pediatric patients' perspectives, particularly adolescents. The study underscores the importance of enhancing environmental design in pediatric palliative care to meet the unique needs of patients and their families.

Anticipatory prescribing in community end-of-life care

ObjectivesOur work aims to critically review the use of anticipatory medicines in our inner-city hospice community population and whether our current practices are fit for purpose.MethodsRetrospective audit of community palliative...

The Effects of Mindfulness-Based Breathing on Strain, Burden, and Burnout in Family Caregivers of Palliative Care Patients: Randomized Controlled Study.

The aim of this study was to assess the effects of online mindfulness-based breathing therapy combined with music on the levels of perceived strain, caregiver burden and burnout in caregivers of palliative care patients. This was a prospective, single-blind, randomized-controlled study. A total of 100 caregivers were randomly assigned to the intervention group (n = 50) and the control group (n = 50). Participants in the intervention group agreed to 3 sessions of mindfulness-based breathing therapy per week. Participants in the control group agreed to sit in a comfortable position in a quiet environment for 30 minutes for 3 consecutive days. We found statistical differences in groups in strain (P < .001), burden (P = .015) and burnout (P = .039) when comparing intervention and control groups. Mindfulness-based breathing therapy combined with music is a non-pharmacological approach that may reduce perceived strain, caregiver burden and burnout in caregivers.

Effect of logotherapy counseling program on chronic sorrow, dignity, and meaning in life of palliative care patients: a randomized controlled trial.

Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients. This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care. The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation. Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients. Clinicaltrials registration number and date: NCT05129059, 19/01/2021.