Life In Palliative Care Research Articles

Medication strategies: enhancing symptom management and quality of life in palliative care

Background: Palliative care is integral to addressing suffering during advanced illnesses, and tailored medication is crucial. This study aims to explore medication patterns in palliative care, focusing on understanding their impact on symptom management and patient well-being. Methods: Data collection involves a retrospective approach with patients referred to the Community Support Team in Palliative Care of the Trás-os-Montes and Alto Douro Local Health Unit between April 2022 and March 2023. Data are recorded, including demographic information, medical history, and pain-related details. Medication is administered based on healthcare professionals’ judgment, following established pain management guidelines. Descriptive and cross-tabulation techniques are employed for the statistical analysis. Results: Key findings highlight Morphine and Paracetamol as primary analgesics, constituting 14.6% and 13.8%, respectively. Fentanyl, identified as a potent opioid, addresses severe pain at a rate of 10.0%. The study also reveals that 23.7% of cancer patients receive palliative sedation, emphasising its role in symptom control and dignified care. Conclusions: This research provides significant insights into the intricate relationship between medication administration and palliative care outcomes. The study reveals key findings, such as the prominence of Morphine, Paracetamol, and Fentanyl as essential analgesics in addressing pain and improving patient comfort. Additionally, the high prevalence of palliative sedation among cancer patients underscores its crucial role in symptom control and ensuring dignified care at the end of life. The complexity of medication choices within palliative care settings is emphasised, highlighting the need for careful consideration and tailored approaches.

The Combined Use of Acute Regional and Interventional Pain Offers Superior Quality of Life in Palliative Care

BACKGROUND: Pain is a common symptom associated with cancer and can greatly compromise quality of life, motivation, and further treatments. Intrathecal pump (ITP) offers improved pain scores and clinical outcomes, while reducing the adverse effects of systemic analgesics. CASE REPORT: A 29-year-old woman with neurofibromatosis type 1 had a malignant peripheral nerve sheath tumor in her right thigh surgically resected. However, one month later, metastatic lesions were found throughout her body. Despite chemotherapy, the disease spread and pain became severe resulting in multiple hospitalizations and halting treatment. Multimodal analgesia was pursued, including regional anesthesia, but she was unable to tolerate the adverse effects of systemic opioids. For long-term analgesia, ITP was pursued, which significantly improved her pain control and quality of life. CONCLUSIONS: In advanced stages of cancer, we highlight the significant benefits ITP offers with improved quality of life and reduced medication side-effect profiles vs systemic analgesics. KEY WORDS: Intrathecal pump, regional anesthesia, palliative care, cancer, chronic pain, opioids

Quality of Life in Palliative Care: A Systematic Meta-Review of Reviews and Meta-Analyses.

The area of palliative care is a setting in which the evaluation of the quality of life (QoL) is fundamental. However, the topic has been covered from many different points of view, and there is a lack of comprehensive synthesis of the evidence drawn from the available literature. We carried out a meta-review of all available systematic reviews and meta-analyses that have dedicated part or most of the investigation to the assessment of QoL in palliative care to provide the most updated and comprehensive depiction of all available information about measurement and intervention aimed at improving QoL in palliative care. A meta-review of all recent (5 years) available systematic reviews and meta-analyses on "palliative care" and "quality of life" was carried out. The quality of the extracted studies was assessed with the AMSTAR scale. The search extracted 24 systematic reviews, 14 systematic reviews followed by a meta-analysis on a subset of data, and 2 meta-analyses. In many studies, the investigation of QoL represented a secondary or even marginal outcome. In general, the results supported the efficacy of palliative care in terminal patients or patients with a permanent disability. However, the quality of the studies had a strong influence on the chance that some improvement in QoL was found in relation to palliative care. Studies of lower quality were more likely to report some efficacy of palliative care than studies with better quality. The investigation of QoL in palliative care is understudied. In many studies, QoL is a secondary outcome, and there is some tendency to use a disparate range of tools to measure it, whose reliability and validity should still be established in some groups of patients.

Réalité virtuelle et santé des personnes âgées institutionnalisées. Vers un EHPAD 2.0 ?

Virtual reality (VR) is used in general health care: prevention, physical medicine, chronic and acute pain, quality of life in palliative care, and in psychiatry: anxiety, depression, addiction, psychosis. Our objective is showing VR using among elderly people in French retirement home. Virtual reality is showing efficacy as distraction, anti-pain, tranquillising, antidepressant methods. It should be an answer to many elderly health problems. VR is easy to use, with low side effects. Non-drug treatments among elderly people are recommended. Used as complementary or alternative medicine, VR must be shaped for using with old and fragile people in retirement home.

Assessing quality of life in palliative care

Assessing quality of life in palliative care

Anorexia: um Desafio Alimentar em Cuidados Paliativos

Anorexia is a symptom characterized by partial or total reduction of appetite leading to weight loss and nutritional deficiency. It can be triggered by several metabolic and immune disorders. Feeding an advanced cancer patient is a challenge due to various physiological, psychological and social factors that can be an impediment to proper protein and caloric intake. Palliative care consists of a set of practical assistance measures for advanced cancer patients who require special care for addressing serious, chronic, degenerative, progressive, and life-threatening illnesses. Focusing on the conviction that nutritional intervention can significantly improve an advanced cancer patient's quality of life in palliative care, this article addresses the importance of debate on eating challenges in anorexia as well as highlights the dietitian’s role in multidisciplinary team.

Measuring quality of life in palliative care for Parkinson's disease: A clinimetric comparison

IntroductionQuality of life (QOL) assessments allow for more complete evaluation of patients' lived experiences in relation to chronic conditions, such as Parkinson's disease (PD). In palliative care, such instruments are vital to ensure QOL issues are catalogued and addressed for patients. However, little is known regarding the psychometric properties of quality of life scales for use in palliative care for PD, specifically. Methods210 participants with parkinsonian disorders, who participated in a larger palliative intervention clinical trial, completed four quality of life scales (PDQ-39, PROMIS-29, QOL-AD, and McGill QOL) at baseline and post-intervention. Psychometric properties, including internal consistency and concurrent validity, were examined. Factor analyses were performed to evaluate relationships between scale items. Minimal clinically important differences (MCID) and responsiveness were calculated for each scale. ResultsAll scales demonstrated good internal consistency and concurrent validity. Factor analyses revealed few deviations from the defined subdomains of the scales. Mean absolute MCID values were estimated at 12.7, 10.9, 3.9, and 18.9 for PDQ-39, PROMIS-29, QOL-AD, and McGill QOL, respectively. The PDQ-39 and PROMIS-29 demonstrated higher responsiveness to palliative intervention, while the QOL-AD was more responsive in the control group. ConclusionsThe PDQ-39, PROMIS-29, QOL-AD, and McGill QOL are all valid for use in PD palliative care, though subdomains of the scales in this population may differ slightly from those initially defined. We recommend the use of PDQ-39 and PROMIS-29 as outcome measures in clinical trials for palliative care in PD, though the QOL-AD may be superior for tracking disease progression.

Integrating Art and Narrative to Enhance Quality of Life in Palliative Care

Integrating Art and Narrative to Enhance Quality of Life in Palliative Care

Missed opportunity? Worsening breathlessness as a harbinger of death: acohort study.

The aim of the study was to explore trajectories of breathlessness intensity by function and life-limiting illness diagnosis in the last 3 weeks of life in palliative care patients.A prospective, consecutive cohort study obtained point-of-care data of patients of Silver Chain Hospice Care Service (Perth, Australia) over the period 2011-2014 (n=6801; 51 494 data-points). Breathlessness intensity (0-10 numerical rating scale) and physical function (Australia-modified Karnofsky Performance Status (AKPS)) were measured at each visit. Time was anchored at death. Breathlessness trajectory was analysed by physical function and diagnosis using mixed effects regression.Mean±sd age was 71.5±15.1 years and 55.2% were male, most with cancer. The last recorded AKPS was >40 for 26.8%. Breathlessness was worst in people with cardiorespiratory disease and AKPS >40, and breathlessness in the last week of life increased most in this group (adjusted mean 2.92 versus all others 1.51; p=0.0001). The only significant interaction was with diagnosis and function in the last week of life (p<0.0001).Breathlessness is more intense and increases more in people with better function and cardiorespiratory disease immediately before death. Whether there are reversible causes for these people should be explored prospectively. Omitting function from previous population estimates may have overestimated breathlessness intensity for many patients in the days preceding death.

The Impact of Ozone Therapy on Antioxidant Status and Quality of Life in Palliative Care - Exploratory Study

There is a constant concern about finding new or alternative therapeutical approaches for symptom control and quality of life that are essential in palliative care. Ozone therapy has been studied for over a century, since the development of the first medical ozone-generator able to ensure a correct titration of the ozone-oxygen mixture. When used in precise therapeutic doses O3 prove many consistent and safe therapeutic benefits, with minimal and preventable side actions. Our prospective exploratory study aimed to analyze the effects of ozone therapy administration on palliative care patients, by dynamically monitoring the antioxidant status (superoxide-dismutase and glutathione-peroxidase serum levels), pain perception, and quality of life. The results confirm ozone therapy as a promising alternative adjuvant therapy for increasing the quality of life in palliative care services.

Quality of Life in Palliative Care.

A main goals of palliative care is to improve the health-related quality of life (QOL) of patients with advanced illnesses. The objective of this narrative review is to provide an updated synopsis on the use of QOL questionnaires in the palliative care setting. Focusing on the palliative cares setting, we will define QOL, discuss how QOL instruments can be used clinically and in research, review approaches to validate these questionnaires, and how they can be used in utility analyses. Several QOL questionnaires, such as EORTC-QLQ-C30, McGill QOL questionnaire and EQ-5D have been validated in the palliative care setting. However, significant gaps impede their application, including lack of determination of their responsiveness to change and minimal clinically important differences, the need to conduct more psychometric validation on QOL questionnaires among patients at various stages of disease trajectory, and the paucity of studies examining utility and cost-effectiveness. Further research is needed to address these knowledge gaps so QOL questionnaires can be better used to inform clinical practice and research.

Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients

ContextSpiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context. ObjectivesThe aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL. MethodsA cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0–10). ResultsTwo hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR “private religiosity” score, as well as the HADS “depression” score. ConclusionBoth spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.

Measurement of Quality of Life in Palliative Care: Evidence for Criterion-Oriented Validity of a Single-Item Approach.

Assessment of quality of life is of central importance in palliative care to understand patients' needs and improve their treatment. However, due to the severely compromised state of health of the severely ill or dying patients, the possibility of an adequate assessment with longer questionnaires is limited. Investigation of the criterion-oriented validity of a single item to measure quality of life in palliative care patients. In a cross-sectional study, correlations of the single item with established questionnaires were analyzed. At Malteser Hospital Bonn and Bonn University Hospital, 72 palliative patients, mainly suffering from cancer, were investigated. Clinical symptoms were measured by the Minimal Documentation System (MIDOS) and quality of life was assessed by the single item "How satisfied are you currently with your physical and emotional well-being?" on a 7-point scale as well as by the Functional Assessment of Cancer Therapy-General (FACT-G) and the Palliative Outcome Scale (POS). Seventy-one of 72 patients filled in the single item and the POS, 64 patients the FACT-G. There was a high correlation between the assessment of quality of life by the single item and the FACT-G (r = 0.695, p < 0.01) as well as the POS (r = -0.630, p < 0.01). The study confirms the criterion-oriented validity of the single item to measure quality of life in palliative care patients. This can be seen as a first step to validate this economic instrument. Future studies should focus on the analysis of further psychometric aspects (e.g., reliability, sensitivity to change) of the single item.

Chaplains Play Important Part in Integrated Palliative Care

Chaplains Play Important Part in Integrated Palliative Care

Music therapy for end-of-life care: An updated systematic review

Background: Music therapy during palliative and end-of-life care is well established and positive benefits for patients have been reported. Aim: Assess the effectiveness of music therapy versus standard care alone or standard care in combination with other therapies for improving psychological, physiological and social outcomes among adult patients in any palliative care setting. Data sources: In order to update an existing Cochrane systematic review, we searched MEDLINE, CINAHL, EMBASE, PsycINFO, CENTRAL, ClinicalTrials.gov register and Current Controlled Trials register to identify randomised or quasi-randomised controlled trials published between 2009 and April 2015. Nine electronic music therapy journals were searched from 2009 until April 2015, along with reference lists and contact was made with key experts in music therapy. Only studies published in English were eligible for inclusion. Two reviewers independently screened titles, abstracts, assessed relevant studies for eligibility, extracted data and judged risk of bias for included studies. Disagreements were resolved through discussion with a third reviewer. Data were synthesised in Revman using the random effects model. Heterogeneity was assessed using I2. Results: Three studies were included in the review. Findings suggest that music therapy may be effective for helping to reduce pain in palliative care patients (standard mean deviation = −0.42, 95% confidence interval = −0.68 to −0.17, p = 0.001). Conclusion: Available evidence did not support the use of music therapy to improve overall quality of life in palliative care. While this review suggests that music therapy may be effective for reducing pain, this is based on studies with a high risk of bias. Further high-quality research is required.

Spiritual Assessment within Clinical Interventions Focused on Quality of Life Assessment in Palliative Care: A Secondary Analysis of a Systematic Review

One of the most crucial palliative care challenges is in determining how patients’ needs are defined and assessed. Although physical and psychological needs are commonly documented in patient’s charts, spiritual needs are less frequently reported. The aim of this review was to determine which explicit, longitudinal documentation of spiritual concerns would sufficiently affect clinical care to alleviate spiritual distress or promote spiritual wellbeing. A secondary analysis of a systematic review originally aimed at appraising the effectiveness of complex interventions focused on quality of life in palliative care was conducted. Five databases were searched for articles reporting interventions focused on QoL including at least two or more QoL dimensions. A narrative synthesis was performed to synthesize findings. In total, 10 studies were included. Only three studies included spiritual wellbeing assessment. Spirituality tools used to assess spiritual wellbeing were different between studies: Hospital QoL Index 14; Spiritual Needs Inventory; Missoula-Vitas QoL Index; and the Needs Assessment Tool: Progressive Disease-Cancer. Only one study reported a healthcare professional’s session training in the use of the QoL tool. Two out of three studies showed in participants an improvement in spiritual wellbeing, but changes in spiritual wellbeing scores were not significant. Overall patients receiving interventions focused on QoL assessment experienced both improvements in their QoL and in their spiritual needs. Although spiritual changes were not significant, the results provide evidence that a spiritual need exists and that spiritual care should be appropriately planned and delivered. Spiritual needs assessment precedes spiritual caring. It is essential that interventions focused on QoL assessment in palliative care include training on how to conduct a spiritual assessment and appropriate interventions to be offered to patients to address their spiritual needs.

Breathlessness During the Last Week of Life in Palliative Care: An Australian Prospective, Longitudinal Study

ContextBreathlessness is a major cause of suffering and distress, and little is known about the trajectory of breathlessness near death. ObjectivesTo determine the trajectory and clinical-demographic factors associated with breathlessness in the last week of life in patients receiving specialist palliative care. MethodsThis was a prospective, longitudinal cohort study using national data on specialist palliative care from the Australian Palliative Care Outcomes Collaboration. We included patients in the Australian Palliative Care Outcomes Collaboration who died between July 1, 2013 and June 30, 2014 with at least one measurement of breathlessness on a 0–10 numerical rating scale in the week before death. The trajectory and factors associated with breathlessness were analyzed using multivariate random-effects linear regression. ResultsA total 12,778 patients from 87 services (33,404 data points) were analyzed. The average observed breathlessness was 2.1 points and remained constant over time. Thirty-five percent reported moderate to severe distress (numerical rating scale ≥4) at some time in their last week. Factors associated with higher breathlessness were younger age, male gender, cardiopulmonary involvement, concurrent fatigue, nausea, pain, sleeping problems, higher Australia-modified Karnofsky Performance Status, and clinical instability in the multivariate analysis. Respiratory failure showed the largest association (mean adjusted difference 3.1 points; 95% confidence interval, 2.8–3.4). ConclusionAlthough breathlessness has been reported to worsen in the last months, the mean severity remained stable in the final week of life. In specialized palliative care, one in three people experienced significant breathlessness especially in respiratory disease.

Correlation between patient quality of life in palliative care and burden of their family caregivers: a prospective observational cohort study

BackgroundFamily caregivers play a key role in palliative care at home, and understanding the interdependencies in the constellation of patient, family caregivers and service providers is important. As few longitudinal studies have examined the influence of patient quality of life (QoL) in palliative care on burden of family caregivers, the aim of this study was to identify correlations between changing patient QoL and changing burden of family caregivers that need consideration in patient management.MethodsPalliative patients with cancer in primary care evaluated their QoL (Quality of Life Questionnaire Core 15 Palliative Care, QLQ-C15-PAL). They were assessed monthly for an interval of 6 months or until death of the patient. Family caregivers reported the burden they perceived while supporting the patient (Short form of the Burden Scale for Family Caregivers, BSFC). Longitudinal data were analysed for all patients with at least 3 available assessments, considering the most recent data for participants with more than 3 assessments. Changes in patient QoL were analysed using the Friedman test. In a stepwise regression analysis, influences of change in patient QoL on changing caregiver burden were investigated.ResultsOne hundred patients (63 men, 37 women; average age: 68 years) were enrolled in the study. The most common primary diagnoses were colon, lung or breast cancer. In 58 cases, assessments were available from both patients and caregivers. Patients reported overall quality of life increasing towards end of life, although reporting that physical functioning deteriorated. Symptoms of pain and fatigue bothered patients most. Caregiver burden was moderate and on average did not change over time. In a stepwise regression model, the difference in emotional functioning and the difference in dyspnoea showed an influence on the development of caregiver burden (explained variance of 19.3 %).ConclusionsPatients’ dyspnoea, feelings of depression and anxiety impacted on the perceived burden of family caregivers, but are manageable symptoms. Our results corroborate the need of regular assessment of patients’ needs taking into account caregiver burden. In this way, general practice teams can intervene early and may more likely meet patients’ needs in the end of life care process.Trial registrationCurrent Controlled Trials ISRCTN78021852, assigned on 04/04/2007

Prevalence of Hyponatremia in Palliative Care Patients.

Introduction:Hyponatremia is an undertreated finding in clinical practice. It is the most common electrolyte abnormality. Hyponatremia can be asymptomatic or can cause symptoms ranging from nausea and lethargy to convulsions and coma. Palliative care patients have a multitude of symptoms and there are several contributing factors towards this. Hyponatremia could be one of the contributing factors. Looking at the prevalence of hyponatremia would highlight the magnitude of the problem and would prompt healthcare professionals to investigate and treat hyponatremia in palliative care patients, which in turn might reduce symptoms such as fatigue and nausea. This could improve the quality of life in palliative care patients.Aim:To assess the prevalence of hyponatremia among patients referred for palliative care in a tertiary care hospital.Methodology:This is a descriptive study, with retrospective analysis of consecutive patient charts for 5 years. The sodium levels at the time of referral for palliative care, was reviewed. Inferential statistics for the result was calculated using the Z-test.Results:Of the 2666 consecutive patient charts that were reviewed, sodium values were recorded in 796 charts. Among the recorded charts, 28.8 % of patients showed hyponatremia at the time of referral which was significant with a P value of 0.000 (<0.05). Of these, 61.1 % had malignancy as their diagnosis and the rest had nonmalignant diseases, ranging from trauma to chronic obstructive pulmonary disease.Conclusions:Prevalence of hyponatremia is significant in palliative care patients. A prospective study looking at the causes and clinical outcomes associated with hyponatremia in palliative care patients is needed.

Assessment and Treatment of Chemotherapy-induced Peripheral Neuropathy- a Physical Therapy Perspective

Chemotherapy is recognized as a mainline treatment for all types of cancer, and its most debilitating and dose-limiting complication is Chemotherapy-induced peripheral neuropathy (CIPN), the mechanisms of nerve damage of which depends upon the specific chemotherapeutic agent used. Use of non-invasive treatment methods such as physical therapy may provide a valuable therapeutic adjunctive option in patients with CIPN. Physical therapy treatment methods had been shown to produce effective symptom control and enhance quality of life in palliative care. A detailed evidence-based update of literature is provided under evaluation and management of CIPN with a special perspective of physical therapy management using a proposed clinical reasoning-based treatment decision making algorithm so that an ‘out of the box’ self-reflective evidence-informed critical thinking process is applied along a collaborative multidisciplinary biopsychosocial approach. Keywords: Chemotherapy-induced neurotoxicity; Chemotherapy-induced neuropathy; Physical therapy; Palliative rehabilitation