Patients In Palliative Care Unit Research Articles

Views of admitted palliative care patients and their clinicians on corneal donation discussions: a qualitative content analysis of semi-structured interviews

BackgroundThere is a severe shortage of corneas for donation, globally, for transplantation and research purposes. One group of individuals who could potentially be donors are those who die within the inpatient palliative care unit. The aim of the study was to understand clinician and patient perceptions of corneal donations and discussion of donation in palliative care units.MethodsA qualitative design was utilised with data collected through semi-structured interviews and analysed using qualitative content analysis. A total of 46 interviews were undertaken involving inpatient palliative care unit patients (19) and clinicians (27) in three major inpatient palliative care units in South Australia.ResultsVery few patient participants reported being asked about corneal donations during their time in palliative care. Most inpatient palliative care unit clinicians did not raise the topic as they felt other areas of care took precedence. Inpatient palliative care unit patients thought if inpatient palliative care unit clinicians did not raise the topic, then it was not important. There were some differences between patient and clinician views, such as preference about who raises the possibility of donation and when the discussion might occur.ConclusionsFindings suggest that patients are receptive to discussing corneal donations, but clinicians are not initiating these. This is a missed opportunity for donors and potential recipients. We recommend that clinicians routinely discuss eye donation as part of palliative care.

Symptom burden and relief in palliative care units of German Comprehensive Cancer Center and other hospitals

PurposeThe National Hospice and Palliative Registry contains patient data from German hospice and palliative care facilities about symptoms. The aim of the study at hand is to differentiate symptom burden of patients in palliative care units between Comprehensive Cancer Center (CCC) and other hospitals regarding symptom burden and relief of patients in palliative care units.MethodsThe registry analysis provided data of patients in palliative care units (2014–2018). We analyzed characteristic and symptom-related data on 18 symptoms, with considerable symptom-burdened patients (moderate or severe). We followed a cancer (yes/no) and facility-specific descriptive analysis (f, %, μ, Mdn, SD, V, r) using SPSS.ResultsWe evaluated 10,447 patient records (CCC: 4234 pts/non CCC 6,213 pts), 82% with a cancer diagnosis. For cancer patients, the mean age in CCC-affiliated palliative care units was 68 (SD 19–99) years, in others 73 (SD 23–104) years (p < 0.05; V = 0.2). The proportion of patients with significant symptom burden is lower in CCC-affiliated than in other palliative care units. The difference between facilities shows a significant weak effect in pain, vomiting and constipation, depressiveness, anxiety, and tension. The proportion of cases which symptom burden could be alleviated is higher in CCC-affiliated palliative care units with significant weak/medium effect in pain, nausea, vomiting, shortness of breath, constipation, wound care problems, depressiveness, anxiety, tension, confusion, and problems in organizing care.ConclusionWe found differences in symptom burden and symptom relief between CCC-affiliated and other palliative care units. CCCs should continue to feel responsible for sharing knowledge about symptom relief, such as through standard operating procedures and education.

تاثير معرفة الممرض والكفائة الذاتية على فعالية الحياة واضطرابات الاعراض على مرضى سرطان المعدة في دور الرعاية التلطيفية في الاردن

Gastric cancer is one of the most prevalent and fatal cancers that has been reported around the world. Numerous studies reported poor and limited nurses' knowledge of palliative care services. Despite the numerous measures Jordan has taken to improve the palliative care concept, Jordan still confronts numerous difficulties and issues. This review of the literature on nurses' self-efficacy and knowledge while providing palliative care to patients with gastric cancer and nurses' perceptions of the barriers and needs towards palliative care services. The literature suggests that nurses have poor self-efficacy and knowledge concerning managing cancer symptoms, enhancement of quality of life, and therapy management plans (like opioids) for patients in palliative care units. Unfortunately, few studies have focused on palliative care in Jordan. This suggests a significant gap in literature studies on palliative care in Jordan.

Need for Improvement in Death Pronouncements in Palliative Care Units.

Death pronouncement is an important moment that can impact a family's bereavement process; however, necessary improvements in physicians' behavior during death pronouncement remain unclear. To explore whether the lack of certain behaviors by the physician was associated with a perceived need for improving death pronouncement for advanced cancer patients in palliative care units (PCUs). This study was a secondary analysis of a nationwide multicenter questionnaire survey conducted in 2018 that targeted bereaved family members of cancer patients who died in PCUs. We performed univariate analysis to investigate the need to improve behavior toward death pronouncement. We performed bivariate analysis to investigate the relationship among the need for improvement in behavior toward death pronouncement, physician attribution (primary responsible physician, a member of the same team, and another physician), and nine specific behaviors. Four hundred twenty-two questionnaires (64.2%) were returned. We analyzed 356 responses and found that 32.5% perceived the need to improve death pronouncement. Lack of certain behaviors at death pronouncement, especially not explicitly explaining the cause of death to family members (odds ratio: 11.89, p < 0.001), were positively associated with the need for improvement. There were significant differences among the types of physician attribution regarding the need for improvement (primary responsible physician vs. a member of the same team vs. another physician [15.1% vs. 42.6% vs. 45.7%, p < 0.001]). There was a significant positive association between the lack of certain behaviors toward death pronouncement and the need for improvement. The major lack of behavior toward death pronouncement was not explicitly explaining the cause of death to family members and not calling out to the patient before beginning the patient's examination.

The selection of patients in palliative care units, a necessary condition for maintaining care

« Les humanités en santé : approches de terrain » sont coordonnées par Claire Crignon, professeure d’histoire et de philosophie des sciences à l’université de Lorraine, qui a créé le master « humanités biomédicales » à Sorbonne université.

Iron Deficiency Anemia in Cancer Patients in Palliative Care

In this study, we aimed to investigate the effects of anemia on the prognosis by comparing the severity of anemia with several prognostic factors including metastases, functional performance, and the feeding status of cancer patients.This study included 189 cancer patients, who received treatment in the palliative care unit (PCU). Demographic characteristics of the patients, anemia test panel results, chemotherapy, the status of metastases, functional performance, the length of hospital stay, and the status at discharge were recorded and compared between the study groups. Of the cancer patients in PCU, 85.7% had anemia and 88.4% had metastases. In patients with severe anemia, the Eastern Cooperative Oncology Group Scale (ECOG) performance scores were lower and C-reactive protein (CRP) levels were significantly higher compared to the other patients in other groups (p=0.045, p=0.000). Glasgow Coma Scales (GCS) were found to be significantly lower in patients with moderate anemia than those without anemia. (p=0.049) We have shown that there is a correlation between the severity of anemia and poor prognostic criteria including low ECOG, GCS scores and high CRP levels in advanced cancer patients we treated in PCU. The early assessment of anemia and the adequate intake of nutrients along with iron supplements should be ensured in cancer patients during the disease course.

Pressure Ulcers in Palliative Care Unit Patients

Pressure Ulcers in Palliative Care Unit Patients

The Effect of the Meditation Based Mandala Programme on Distress, Anxiety and Depression in the Caregivers of Cancer Patients in Palliative Care Unit.

Mental health problems were found to be more common than physical health problems in cancer caregivers in palliative care units. This is a quasi-experimental study planned to determine the effect of the meditation based mandala programme on distress, anxiety and depression in caregivers of cancer patients in a palliative care unit. Planned as a single-group pre-test/post-test design, with a total of 11 caregivers. Data were collected with the Caregiver Diagnosis Form, Distress Thermometer, Beck Depression Inventory, and Beck Anxiety Inventory. Caregivers participated in the Meditation Based Mandala Programme once a week, which lasted 2hours for 5weeks. The distress, depression and anxiety levels of the patients were measured before the programme started and at the end of the programme. Meditation based mandala programme is effective in reducing the distress, depression and anxiety levels of caregivers of cancer patients in the palliative care unit.

Role of systemic immune-inflammation index in predicting mortality in cancer patients in palliative care units

Aim: In our study, we aimed to investigate whether the systemic immune-inflammation index (SII) can evaluate mortality in cancer patients treated in the palliative care unit (PCU).&#x0D; Material and Method: Cancer patients who received palliative care treatments in the PCU were screened retrospectively, and 309 patients were included in the study. The patients were divided into two groups; hospitalizations ending with discharge as Group 1 (n=154) and hospitalizations ending with exitus as Group 2 (n=155). SII values of the two groups were compared. SII was calculated with the formula of neutrophil count x platelet count / lymphocyte count. To determine the best cut-off value for the mortality distinction ability of the SII, a Receiver Operating Curve (ROC) analysis was used.&#x0D; Results: The mean age and distribution of genders of the two groups were similar (p=0.706, p=0.964). There was a statistically significant difference between the SII values of the two groups (p

The Impact of Visitor Restrictions During COVID-19 Pandemic on Bereaved Family Members of Patients in Palliative Care Units.

COVID-19 pandemic has impacted the families of patients in Palliative Care Units because of the visitor restrictions which were introduced to reduce the risk of infection. This study investigates how the bereaved families of the patients who died in end-of-life care during the pandemic evaluate the visitor restrictions and how the lack of direct communication with the patient affected them. We conducted a quantitative survey using an anonymous self-administered questionnaire. Participants were the bereaved families of patients who died in a Palliative Care Unit from April 2020 to March 2021. Their perspectives on the negative impact of COVID-19 pandemic on visitations, visitor restrictions, the quality of medical care in the month before the death of the patient, and online visitations were recorded in the survey. The results show that most participants experienced a negative impact on visitations. However, most respondents felt that the restrictions were unavoidable. According to visitor permissions in patients' last days, bereaved families were satisfied with the medical care provided for the patient and the amount of time spent with the patient in his/her last days. The importance of direct meetings during the last days of the patients' life for their family members was presented. We suggest further research to find measures which enable visitation in palliative care units, as caregiving from family and friends and maintaining COVID safety regulations are equally significant in end-of-life care.

Right needle, right patient, right time? A national flash-mob audit of thromboprophylaxis in palliative care

BackgroundThe prevention of hospital associated thrombosis in palliative care remains controversial yet many countries recommend the documented risk assessment and where appropriate pharmacological prophylaxis of inpatients with advanced cancer. AimTo audit adherence to national guidelines which require hospitalised patients to be risk assessed and receive appropriate thromboprophylaxis. DesignA one day “flash-mob” audit across multiple clinical inpatient sites across the United Kingdom. Setting/participantsInpatients receiving palliative care within hospitals, hospices and specialist palliative care units across the United Kingdom. ResultsData were collected from 1125 patients (514 hospital and 611 hospice/specialist palliative care units). Appropriate thromboprophylaxis was observed in 90 % of hospital and 90 % hospice/specialist palliative care units. Documented risk assessment was only found in 79 % and 71 % of patient notes respectively. Pharmacological thromboprophylaxis was contraindicated in 88 % of hospice/specialist palliative care unit patients due to bleeding risk or receiving end-of-life care. Twenty-four percent of patients in hospital had contraindications due to receiving end of life care, bleeding risk and thrombocytopenia. Patients in hospice/specialist palliative care units were of poorer performance status prior to admission with a history of gradual deterioration. Hospitalised patients were more likely to have been admitted following an acute deterioration of previous good performance status. ConclusionThromboprophylaxis guidelines were followed correctly for the majority of patients. There were considerable differences in the demographics of patients according to place of admission. Patients admitted to hospice/specialist palliative care units were sicker and had more contraindications to prophylaxis than those admitted to hospital. Thromboprophylaxis focused research data conducted in hospices is unlikely to be applicable to the care of palliative care patients admitted acutely to hospital.

Low-dose sublingual fentanyl improves quality of life in patients with breakthrough cancer pain in palliative care.

Aim: This subanalysis of the CAVIDIOPAL study evaluated the impact of individualized management of breakthrough cancer pain (BTcP) with fentanyl on the quality of life (QoL) of advanced cancer patients in Spanish palliative care units. Patients & methods: This was a prospective, observational, multicenter study. The European Organization for Research and Treatment of Cancer's QLQ-C30 questionnaire was used at baseline (V0) and visit 28 (V28). Results: Ninety-five patients were mainly treated with 67-133μg fentanyl, showing a notable reduction in intensity (visual analog scale: 8.0 [V0] to 4.6 [V28]), frequency and duration of BTcPepisodes shortly after the first 1-2weeks of treatment, with significantly improved QoL (global health status: 31.1 [V0] to 53.1 [V28]). Conclusion: Low-dose sublingual fentanyl effectively reduced BTcPin advanced cancer patients in palliative care units, significantly improving QoL. Clinical trial registration: NCT02840500 (ClinicalTrials.gov).

Health- and disease-related data of inpatients in palliative care units of the Comprehensive Cancer Centers and other hospitals in comparison-Data from the Hospice and Palliative Care Register

The National Hospice and Palliative Registry is adatabase for palliative care facilities documenting acore data set for quality assurance and scientific evaluations. The study aims identifying differences between patients in palliative care units treated in Comprehensive Cancer Centers (CCC) or other hospitals (OH) focussing on sociodemographic and health/disease-related characteristics. Descriptive data analysis using IBM SPSS Statistics21 included patients treated from 2014 to 2018. Comparisons included sociodemographic data, diagnoses, ECOG status and treatment duration. 12,922 patient data were analyzed (CCC n = 4975/OH = 7947). In CCCs 79.8% had atumor diagnosis, in other hospitals 85.1%. The proportion of patients with ECOG4 was higher in CCCs than in other hospitals. The average length of stay in CCCs was 12.6days, in other hospitals 11.3days (p = 0.023). Data show differences between patients in palliative care implicating CCCs treating more complex palliative care patients than other hospitals.

Evaluation of symptom severity and life quality of cancer patients in palliative care unit

Evaluation of symptom severity and life quality of cancer patients in palliative care unit

Correlation of Plasma Kynurenic Acid Level with the Severity of Depression, Pain, And the Need of Opioids for Pain Management in Cancer Patients in Palliative Care Unit in Dr. Soetomo General Hospital Surabaya

Introduction: Most cancer cases in Indonesia are diagnosed at an advanced stage, and the cure rate and life expectancy are not as expected. Depression and pain are the most common problems that arise in cancer patients. Kynurenic acid and quinolinic acid are neuroactive metabolites produced in the kynurenine pathway. Decreased kynurenic acid levels have been reported to be associated with depression, pain, and pathology in cancer. Objective: This study aims to determine the correlation between kynurenic acid levels and the severity of depression, pain level, and opioid need in cancer patients undergoing palliative treatment. Material and Method: This study was an observational analytic study with a retrospective cohort design. The study population was adult patients with malignancy in the palliative care unit of Dr. Soetomo General Hospital Surabaya that received opioid treatment during the study period. The sample of this study was 54 patients. Plasma kynurenic acid levels were measured using the ‘Human Kynurenic acid ELISA kit’ from BT Lab. The severity of depression was measured by the Hamilton Depression Rating Scale (HDRS). Pain level was scored with Pain Numeric Rating Scale (NRS), while the opioid use was collected from the patient’s medical record. Result and Discussion: There was a significant relationship between kynurenic acid levels and the severity of depression (p&lt;0.001), pain level (p&lt;0,001), and opioid need (p=0,007). Simple linear regression analysis showed that the lower the kynurenic acid level, the more severe the depression (p&lt;0.001) and the higher the opioid dose needed (p=0,004). Moderate pain has a lower median kynurenic acid level than mild pain, 12.32 nmol/L, and 16.29 nmol/L, respectively. Patients with a lower level of kynurenic acid require a higher dose of the same type of opioid. Conclusion: The lower level of plasma kynurenic acid is associated with more severe depression, more pain level, and more opioid need for pain management in malignancy patients in the palliative care unit of Dr. Soetomo General Hospital Surabaya.

Oral Presentation

Oral Presentation

The efficacy of specialised rehabilitation using the Op-reha Guide for cancer patients in palliative care units: protocol of a multicentre, randomised controlled trial (JORTC-RHB02)

BackgroundAlthough rehabilitation is recommended for terminal cancer patients, the specific components and methods of such programs are poorly documented. No studies to date have examined the effectiveness of rehabilitation for terminal cancer patients. This study aims to evaluate the efficacy of a new intervention for rehabilitation therapists, using the Op-reha Guide (Guide to Optimal and Patient-Centred Rehabilitation Practice for Patients in Palliative Care Units [PCUs]) in rehabilitation practice. This guide consists of recommended actions and attitudes for rehabilitation therapists and aims to optimise therapists’ actions according to the patient’s needs and condition. It shares goals with terminal cancer patients to maintain their activities of daily living (ADL).MethodsThis study uses a multicentre, prospective, randomised controlled trial (RCT) design with two parallel groups in PCUs where specialised rehabilitation will be routinely performed for terminal cancer patients by rehabilitation therapists. Participants will be randomised (1:1) to intervention (the Op-reha Guide) and control groups (usual rehabilitation). We will then conduct an observational study in PCUs that do not perform specialised rehabilitation for terminal cancer patients; this will be considered the usual care group, and the efficacy of usual rehabilitation will be quantitatively evaluated. Inclusion criteria are hospitalisation in PCU, European Cooperative Oncology Group Performance Status of 2 or 3, and clinical estimation of life expectancy of 3 weeks or more. Patients with severe symptom burden will be excluded. We hypothesise that the Op-reha Guide will be more effective in maintaining the ADL of terminal cancer patients hospitalised in PCUs than usual rehabilitation. The primary endpoint is defined as the change in (total) modified Barthel Index from baseline to Day 22. Quality of life will be a secondary endpoint. In total, 135 patients will be recruited from 16 Japanese sites between July 2019 and December 2021.DiscussionThis will be the first trial to evaluate the efficacy of specialised rehabilitation for terminal cancer patients hospitalised in PCUs, and will contribute to the evidence on the efficacy of implementing rehabilitation for terminal cancer patients.Trial registrationUMIN-CTR, UMIN000037298 R000042525 (date of registration 7 July 2019).

Effect of education on preference of parenteral nutrition for patients in palliative care unit: quantitative and qualitative study with an anthropological approach.

Patients and their family have resistance in withholding parenteral nutrition (PN) when patient become unable to intake food in the end-of-life. We aimed to investigate whether the preference for PN is changed after receiving an individual education about the risk and benefit of PN. Additionally, we focused on the preferences of patients and their family and why they prefer it about the nutritional support in the end of life. This is prospective study. Patients are eligible if they cannot tolerate oral intake and enteral feeding and have Palliative Performance Scale (PPS) ≤50% due to progressive cancer. After informed consent, investigators educated patients and family for an hour using the handouts. Then, patients decided if they will receive PN. Quality of life (QOL) was checked by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C15-PAL) weekly during 3 weeks. Symptoms related to fluid overloading or dehydration was surveyed weekly also. A social anthropologist participated as an observer or interviewer during whole process of this study. After education, 12 patients (80%) chose to keep receiving PN and 3 patients (20%) changed their decision from PN to minimal hydration among the 15 patients. More calories were administered to patients who chosen PN (median 1,042.2 vs. 324.3 Kcal/day, P<0.001) for initial 7 days. Overall survival, scores of QLQ-C15-PAL, and symptoms were not different with or without PN. According to the anthropologist, medical staffs regard PN as complex medical treatments, while patients and family recognize it as meal rather than medicine. Most patients and family prefer to receive PN despite its potential harm and marginal benefit. An in-depth discussion about prognosis and aim of care must be preceded before a decision whether to receive PN can be made.

The Accuracy of Imminent Death Diagnosis in a Palliative Care Setting.

BackgroundPrognostication is important for patients and their family members as they need this information for the preparation and planning of their future. It is important for physicians as they desire to be accurate in their prognostication skills in order to plan and deliver better care to their patients; healthcare managers require it as they need this information for planning and distribution of hospital resources. We intended to study the accuracy of imminent death diagnosis (IDD) in a palliative care setting in all patients who died at the Palliative Care Unit (PCU) at King Fahad Medical City between December 2012 and December 2014.MethodsWe conducted a retrospective chart review of all consecutive patients who died in the PCU between 2012 and 2014. We studied the percentage of patients who were diagnosed with imminent death. We further looked at the accuracy of IDD by calculating the time between the diagnosis of imminent death and death. The primary outcomes were the percentage of patients who had an IDD and the proportion of those who died within 14 days of IDD. The secondary outcomes were the difference between patients who die after IDD and patients who die without imminent death diagnosis (NIDD) at the end of life interventions.ResultsDuring the period from December 2012 until December 2014, 48 patients died in the PCU. The majority of 28/48 (58%) died with IDD. However, 20/48 (42%) died NIDD. In the IDD group, 25/28 (89.3%) died within 14 days of diagnosis while 3/28 (10.3%) died after 14 daysConclusionsIDD is a critical skill for palliative care physicians to make an advance care plan. Our study showed a high degree of accuracy of prediction of fourteen-day mortality in PCU patients. The median survival was two days. However, a large proportion of patients still died without a documented IDD. Multidisciplinary team input improves the accuracy of IDD. We recommend further studies be done to explore how IDD could improve care planning for dying patients and families.

Comparison of expenditure between an inpatient palliative care unit and tertiary adult medical and surgical wards for patients at end of life: a retrospective chart analysis.

The highest healthcare expenditures occur towards the end of life. Costs relate to hospital admissions and investigations to diagnose, prognosticate and direct treatment. AnAustralian study to compare the cost of investigations in the last 72 h of life between an inpatient palliative care unit (PCU) and a tertiary hospital. We retrospectively reviewed 50 adult medical and surgical patients (admitted for >72 h and who died in hospital) from the PCU and referring tertiary centre between March and July 2016. Patients in the emergency department, intensive care, medical assessment and paediatric and obstetric units were excluded. All patients had an acute resuscitation plan and were on the 'Care of the Dying' pathway. Expenditure was less if palliative care were the primary caregivers, with statistically significant differences in the amount of imaging (P < 0.001) and pathology (P < 0.001) ordered. There was no difference in microbiology (P = 0.172) and histology (P ~ 1) ordered. Total cost of investigations for PCU patients was $1340.60 (4 of 50 patients) compared with $9467.78 (29 of 50 patients) in the tertiary hospital. PCU patients had longer lengths of stay (15.54 days vs 11.06 days) but cost less per bed day ($868.32 vs $878.79 respectively). Inpatient PCU are less likely to order investigations and are more cost-effective. A prospective study comparing an inpatient PCU and patients at a tertiary centre, with and without consult liaison palliative care input, would be worthwhile to see if outcomes remain the same and if consult liaison palliative care affects the investigative burden.