Non-cancer Palliative Care Research Articles

Comparison of resuscitation intervention utilization in the emergency department by palliative care eligible patients between cancer and non-cancer

Resuscitation interventions are procedures for managing clinical deterioration in patients with life-threatening conditions by securing the airway, maintaining breathing, or supporting circulation. Little is known about differences in the use of resuscitation interventions and the characteristics of patients eligible for palliative care in the emergency department. The objectives of this study are to compare resuscitation interventions in the emergency department between patients with cancer and non-cancer palliative care eligibility. A retrospective cohort study was conducted by reviewing the medical records of the palliative care eligible patients who visited the emergency department of one university hospital between January and June 2019. Among the 956 visits (13.7%) by palliative care eligible patients of 7000 random visits, 480 were patients with cancer (50.2%), and 476 were non-cancer patients (49.8%). The overall median age was 72, and 54.1% were female. The mortality rates in the following year were 35.0% for patients with cancer and 18.7% for non-cancer illnesses. The patients with cancer and non-cancer received prior palliative care at 7.3% and 0.8% (p < 0.001) and initiated palliative care at the emergency department at 6.3% and 2.7%, respectively (p = 0.008). The non-cancer patients utilized overall resuscitation interventions 1.7 times more than the cancer patients (aOR = 1.7, 95% CI = 1.0–2.6, p = 0.030). For the palliative care eligible patients in the emergency department, patients with cancer and non-cancer significantly differed in their characteristics. Patients with non-cancer received more resuscitation interventions than patients with cancer.

Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians

BackgroundRespiratory medicine (RM) and palliative care (PC) physicians’ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey.MethodsA voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists.Results450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018).ConclusionsThese findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled.

Prevalence of Delirium in End-of-Life Palliative Care Patients: An Observational Study

Objectives: The aim of this study was to assess the prevalence of delirium, using the Assessment Test for Delirium and Cognitive Impairment (4AT) in end-of-life palliative care patients. Subjects and Methods: This retrospective cross-sectional study was conducted on end-of-life patients in a hospice or at home. All patients were evaluated with the 4AT for the presence of delirium. Results: Of the 461 patients analyzed, 76 (16.5%) were inpatients and 83.5% (385) outpatients. The median age was 79.5 (72–86) years, and 51.0% were female. According to the 4AT score, 126 patients (27.3%) had delirium (A4T ≥4) at admission, 28 (36.8%) were inpatients, and 98 (25.5%) outpatients. Around 33.8% of the cancer inpatients had delirium, while 20.6% of the cancer outpatients had delirium. The prevalence of delirium varied according to the setting, clinical condition, and life expectancy. In addition, 55.0% (11) actively dying inpatients, within 3 days, had delirium, and 56.7% (17) outpatients had delirium; while among those with life expectancy longer than 4 days, 30.4% (17) inpatients and 22.8% (81) outpatients were with delirium. Conclusions: Our study confirms that delirium is common in cancer and noncancer palliative care patients. Further research on delirium in end-of-life palliative care patients should consider the complexity of palliative care of this population as well as of the characteristics of the settings.

How do we manage dyspnea?: the role of opioid for relieving dyspnea in cancer and non-cancer palliative care patients

How do we manage dyspnea?: the role of opioid for relieving dyspnea in cancer and non-cancer palliative care patients

Screening for palliative care needs in the community using SPICT

BackgroundThe Worldwide Hospice Palliative Care Alliance has recommended integration of palliative care into primary health care. Diminished capacity to provide palliative care is a barrier for integration. The purpose of this study was to screen for palliative care needs in the community. MethodsA cross-sectional study was conducted in two rural communities of Udupi district. Supportive and Palliative Care Indicators Tool – 4ALL (SPICT-4ALL) was used to identify the palliative care needs. Purposive sampling was used to collect the individual information from the households for identifying the palliative care need. Conditions requiring palliative care and the sociodemographic factors associated with it were explored. ResultsOut of 2041 participants, 51.49% were female, and 19.65% were elderly. Less than a quarter of them (23.08%) had at least one chronic illness. Hypertension, diabetes, and ischemic heart disease were commonly found. 4.31% had satisfied the requisite SPICT criteria, which indicated a need for palliative care. Diseases of cardiovascular system followed by dementia and frailty were the most common conditions requiring palliative care. Univariate analysis showed that age, marital status, years of education, occupation, and the presence of morbidities were significantly associated with the need for palliative care. Being unemployed and having one or more morbidities were factors independently associated with requirement of palliative care. ConclusionsThe estimated palliative care need in the community survey exceeds the perceived need. Although palliative care is traditionally identified with cancer, the proportion of people with noncancer palliative care needs were significantly higher than cancer palliative care.

Simulation training in non-cancer palliative care for healthcare workers: a systematic review of controlled studies

BackgroundThe need for healthcare workers (HCWs) to have skills and knowledge in non-cancer palliative care has been recognised. Simulation is increasingly being used for palliative care training, offering participants the...

Multisystem chronic illness prognostication in non-oncologic integrated care

ObjectivesTo develop a mortality-predictive model for correct identification of patients with non-cancer multiple chronic conditions who would benefit from palliative care, recognise predictive indicators of death and provide with tools...

Myths that Inhibit the Spread of Palliative Care in India (S733)

•Identify myths about cancer and terminal prognosis that may inhibit the spread of palliative care in India.•Consider strategies to overcome these palliative care myths in India and other developing contexts. Roughly 2% of people have access to palliative pain and symptom management in India. While there are many factors that limit the access to and use of palliative care, this paper aims to identify myths about palliative cancer care and terminal prognosis that may inhibit the adoption and spread of palliative care in India. We use a quota sampling approach to capture the perspectives of local stakeholders from 7 palliative care practice sites throughout India. We collected a total sample of 44 interviews from the following 3 categories (organizational leaders, clinic leaders, and clinical team members) through a semi-structured interview guide. We identified emergent themes using standard qualitative content analysis methods. Myths influencing decision making for palliative care: Theme 1—Cancer is contagious “…cancer is sometimes they[patient]think it is contagious… that is why it affects our [PC] services…” Theme 2—Palliative care is only for patient with cancer “…we are like most organizations in India we are doing mostly cancer palliative care…our training for management of non-cancer palliative care is still very much lacking…” Theme 3—Palliative care is only for end of life “even if you tell a patient that we are referring you to palliative care, they assume that we are actually giving up on actual cancer care..” Theme 4—Quality of life is not relevant when patient has a terminal illness “…probably doctors as well as patients feel that ok we are in the terminal stage why should we need any care kind of a thing…” Theme 5—Managing pain is “giving up.” Myths about what palliative care means and who it is for persist in India and impact perceptions of the appropriateness and acceptability of palliative care.

Managing Pain in Patients With Chronic Medical Illnesses and Serious Mental Illnesses.

This study investigated the use of opioid treatment plans that included the implementation of opioid dependence risk with a validated screening tool and opioid dependence risk tool (UDT) in a noncancer palliative pain clinic. We retrospectively reviewed the medical records for diagnostic information, information on analgesic medications, daily morphine equivalent dose, presence of pain management agreements and opioid dependence risk tools (ORT), and UDT. We recorded hospital days and emergency department visits. Seventy-four patients were followed for a mean of 15.9 months. Ninety-three percent of patients had pain management agreements and 74% had ORT. The median score was 8: consistent with a high risk. More than half had UDT and 17.6% of patients had unexpected findings. Fifty-nine percent of patients had a psychiatric diagnosis. Hospital days and emergency department visits decreased by more than 30% ( P = .015 and P = .019). Significance of Findings: Both mental health problems and aberrant drug use were common in patients seen in a noncancer palliative care clinic. There were significant reductions in acute care utilization in the 12 months post intake in the clinic.

Necesidades de cuidados paliativos en enfermos no oncológicos con enfermedad crónica avanzada: una revisión sistemática

IntroductionA strategic plan of palliative care usually focuses on detecting the needs of non-cancer patients, in order for them to be admitted to palliative care programmes. ObjectiveTo identify the needs of non-cancer palliative care patients with advanced chronic disease. MethodsSystematic review of CINAHL, MEDLINE, Cochrane Library Plus, CUIDEN, Elsevier, LILACS and PsycINFO databases. Results and conclusionsTwenty-two papers were included which met the inclusion and exclusion criteria. Patients’ needs affected their life in all fields. The review highlights the need for healthcare support and palliative care, for information about the disease and for effective symptom management, the need to maintain patients’ functional capacity and to cover emotional and social support needs. Depression, guilt and loss of dignity were the main problems. It is essential to develop palliative protocols involving the evaluation of the non-cancer palliative patient's multi-dimensional needs to guide professionals to establish interventions that address the problems of the patient in a comprehensive manner.

Anticholinergic Drug Burden in Noncancer Versus Cancer Patients Near the End of Life

ContextAnticholinergic drugs can cause several side effects, impairing cognition and quality of life (QOL). Cancer patients are often exposed to increasing cumulative anticholinergic load (ACL) as they approach death, but this burden has not been examined in patients with nonmalignant diseases. ObjectivesTo determine ACL and its impact in noncancer versus cancer palliative care patients. MethodsWe performed a secondary analysis of 244 subjects enrolled in a randomized controlled trial. ACL was quantified with the Anticholinergic Drug Scale. We used multivariable regression to calculate the effect of ACL on key outcomes, including drowsiness, fatigue, and QOL. Patients were stratified by diagnosis, and drugs were grouped as symptom management (SM) or disease management (DM). ResultsOverall, ACL in cancer and noncancer patients was not significantly different (2.6 vs. 2.4; P = 0.23). SM drugs caused greater anticholinergic exposure than DM drugs in both cancer and noncancer patients (2.3 vs. 0.5, and 1.5 vs. 1.3, respectively; both P < 0.05); however, DM drugs exposed noncancer patients to relatively more ACL than cancer patients (1.2 vs. 0.6, P < 0.0001). ACL was associated with worse fatigue (odds ratio, 1.08; CI, 1.002–1.17) and worse QOL (odds ratio, 0.89; CI, 0.80–0.98). ConclusionsACL is associated with worse fatigue and QOL and may not differ significantly between cancer and noncancer patients nearing end of life. SM drugs are more responsible for ACL in cancer and noncancer patients, although DM drugs contribute significantly to ACL in the latter group. We recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.

The PPRISM clinic for non-cancer palliative care and symptom management: Addressing the needs of patients with cirrhosis

The PPRISM clinic for non-cancer palliative care and symptom management: Addressing the needs of patients with cirrhosis

AUDIT OF PALLIATIVE CARE PATIENT IDENTIFICATION IN GENERAL PRACTICE

BackgroundThe Gold Standards Framework highlights the need for early identification of palliative care patients within the community. Thus allowing optimization of patient care and avoidance of unnecessary treatments near the...

Non-cancer palliative care: Experience and challenges faced in a palliative program from Singapore

Palliative care espouses a holistic and multidisciplinary approach applicable to stages of disease in response to needs together with disease-modifying treatments, regardless of diagnosis. While cancer is the single most common killer disease, responsible for 28% of deaths in Singapore in 2007, non-cancer diseases accounted for more than twice that at 66%. Integrating palliative care for patients suffering from end-organ failure would balance curative measures with quality of life for our frailest patients, and support these patients during their final journey. This is only possible with close cooperation between palliative care teams and organ specialists. We report our experience and insights in managing non-cancer cases in an integrative model of care over the past 4 years. We find that most families and patients suffering from end stage non-cancer conditions are able to accept palliative care after honest communication and are able to talk about end-of-life plans. The majority of patients can achieve satisfactory symptom control, be cared for, and die in a place of their choice with the support of a palliative home care program without the need for frequent hospitalizations. Sustaining this model of care requires diligence, collaboration, and upgrading of skills based on coordinated resource allocation.

Noncancer Palliative Care

Little is known about the picture of patients receiving palliative care in the acute care setting. The study was conducted in a medical center in Taiwan. Cancer palliative care (CPC) was performed for terminal do-not-resuscitate (DNR) patients with advanced cancers. Noncancer palliative care (NCPC) was performed for DNR patients who did not fulfill the criteria of CPC. Of the 1379 consecutive admissions, 258 patients were identified, with 193 (74.8%) requiring NCPC and 65 (25.2%) requiring CPC. The NCPC patients were older and had lower Charlson comorbidity index (2.6 vs 8.6, P &lt; .001) than CPC patients and had poorer consciousness and more organ failure than CPC patients when recognized. Many noncancer patients without access to specialist palliative care services were treated in the acute care setting with delayed recognition.

Non-cancer patients in specialized palliative care in Germany: What are the problems?

To determine the role of non-cancer palliative care in inpatient services in Germany, data from the Hospice and Palliative Care Evaluation (HOPE) were analysed. Since 1999, a three-month census has been conducted annually in German palliative care units. Pooled data from 2002–2005 were tested for differences between non-cancer patients (NCs) and cancer patients (Cs). A total of 4182 patients (NC: 3.5%; C: 96.5%) were documented; functional status (using Eastern Cooperative Oncology Group (ECOG) measures) in NCs was lower compared to Cs (p = 0.009). NCs suffered more often from dyspnoea (40%; C: 29%; p = 0.004), weakness (92,3%; C: 84,5%; p = 0.011) and tiredness (75.4%; C: 66.7%; p = 0.03) and less from nausea (17.1%; C: 28.9%; p = 0.002), vomiting (8.2%; C: 19.4%; p = 0.001) or loss of appetite (55.5%; C: 67.9%; p = 0.002). There were no differences in pain and constipation. Other problems (nursing, psychological) were more frequent for NCs, in particular the need for support in the activities of daily life (90.3%; C: 72.8%; p < 0.001) and disorientation/confusion (32.1%; C: 17.2%; p < 0.001). There were no differences in social problems. NCs are still rare in specialized inpatient palliative care institutions in Germany. The palliative care needs in patients with non-malignant disease will challenge the health care system as the workload for these services will grow over proportionally.

Current situation and perspectives of palliative care in Czech Republic

Czech palliative care 2010– an interesting and exciting topic for media and society discussion, searching compromise between „skilla and charibda“ ... euthanasia and dysthanasia – first of all on non-cancer palliative care field, never-ending negotiations with the decision health care makers and health insurance. There is realized a high quality palliative care in Czech Republic but its accessibility is not wide and for majority of dying people. Sociological researches show a paradox of the society will for dying in natural patient environment (80% of respondents) and a real situation when ¾ of all deaths takes place in hospitals, nursing homes or senior houses. Unfortunately health care decision makers still do not support a development of mobile palliative care teams and the community care system. Since 1995 till 2010 most of palliative care in Czech Republic was offered by hospices. Contemporary there are 14 inpatient and several mobile hospices (standing out of the insurance system) in CR. Most of them offer holistic, multidisciplinary palliative care with specialists in medical, psychological, social and spiritual field. Consuptions of opioids in Czech Republic in 2008– according to International Narcotic Control Board: Palliative medicine for non-cancer diagnoses: HIV/AIDS is not an important issue from the public health perspective in Czech Republic –400 cases are described in statistics. As for palliative medicine the patients with end stage disease are treated on specialized infection settings. Palliative care in elderly is a big issue of Czech palliative medicine. First of all in the level of dementia and of course also a topic of care organization in nursing homes, GP's community care and social care environment is widely discussed. The wide discussion about nutrition, hydratation, personal and law ability of decision is going on – in professional and also social environment. Education and perspectives: Pre-gradual medical education in palliative care is offered only at Masaryk University Brno. Czech society for palliative medicine negotiates for the enlarging of these activities. Since 2004 the medical specialty „Palliative medicine and pain treatment“ is recognized in CR. Due to different goals the dividing of both specialties is prepared. Czech society for palliative medicine wants to realize the functional curricula in PM for different medical specialties (i.e. geriatrics, oncology, interne medicine etc.). We lack PM curricula in post-gradual nursing programmes. Czech society for palliative medicine was recognized 2008 in Czech medical association of Jan Evangelista Purkyne. We have identified several steps which are important for the development of multidisciplinary palliative care in Czech Republic. Drug real availability: Policy: Education: Implementation: All these questions are the part of Czech attempt to Budapest commitment process.

117 Developing a Multi-Agency Approach to Improve Non-Cancer Palliative Care Education

A 3-year project to improve access to community palliative care for the residents of the city of Salford (population 216,000) commenced in 2004, funded by the Big Lottery Fund. The major elements were: