Blogger's Note:
“Not everything that can be counted counts and not everything that counts can be counted.” Albert Einstein
~~~~~~~~~~~~~~
Commentary (on Maltoni et al): Palliative Sedation: When and How?
Showing posts with label end of life care. Show all posts
Showing posts with label end of life care. Show all posts
Thursday, April 19, 2012
JCO: Palliative Sedation: When and How? Commentary including references
Blogger's Note:
“Not everything that can be counted counts and not everything that counts can be counted.” Albert Einstein
~~~~~~~~~~~~~~
Commentary (on Maltoni et al): Palliative Sedation: When and How?
Wednesday, April 18, 2012
Where the Oldest Die Now - NYTimes.com
Where the Oldest Die Now - NYTimes.com
".... But if people are being shuttled from home to hospital to nursing home (and possibly around again) during their last days and weeks, that’s nothing to celebrate. “Site-of-death data only tells you where you are at time of death, but nothing about the transitions leading to that point,” Dr. Teno said....."
Sunday, April 01, 2012
Wednesday, March 28, 2012
ScienceDirect.com - Journal of Pain and Symptom Management - Talking About End-of-Life Preferences With Advanced Cancer Patients: Factors Influencing Feasibility
ScienceDirect.com - Journal of Pain and Symptom Management - Talking About End-of-Life Preferences With Advanced Cancer Patients: Factors Influencing Feasibility
Conclusion
Results
indicate that discussing end-of-life preferences in an earlier disease
phase, such as in the OU (outpatient) setting, could be preferable but that its
accomplishment in this setting may be more difficult, mainly as a result
of organizational reasons. This observation could indicate that the
system is not yet ready to offer patients such an opportunity and
although communication on these sensitive issues cannot be reduced to a
procedure, the ELPI can become a useful tool to help physicians in
accomplishing this difficult task.
Friday, February 17, 2012
abstract: Preferences for place of death if faced with advanced cancer: a population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain
Blogger' Note: implications (and distortions) for policy makers continue on this issue aside from this specific paper; assumptions on place of death are generally faulty (IMHO)
~~~~~~~~~~~~~~~
Background: Cancer end-of-life care (EoLC) policies assume people want to die at home. We aimed to examine variations in preferences
for place of death cross-nationally.
Methods: A telephone
survey of a random sample of individuals aged ≥16 in England, Flanders,
Germany, Italy, the Netherlands, Portugal
and Spain. We determined where people would
prefer to die if they had a serious illness such as advanced cancer,
facilitating
circumstances, personal values and experiences
of illness, death and dying.
Wednesday, February 15, 2012
Karolinska Institutet - Complexities in caregiving at the end of life (re: PLOS study)
"...The study indicates three key areas that are sometimes overlooked in palliative care, namely bodily care and contact, a secure, aesthetic and comfortable environment, and death-related rituals.
“The caregivers described different kinds of communication with patients and relatives, from the giving of advice to communication through non-verbal, physical contact,” says Dr Lindqvist. “Rituals surrounding dying and death were not only spiritual or religious but also more subtly existential, legal and professional. One field that has been largely ignored by research is sensory aspects of the caring environment, both at home and in in-patient settings.”
The study also shows that non-pharmacological palliative care is based on a number of complex and sophisticated decisions on the part of the caregiver regarding not only what can be done or should not be done, but also when, how and why to whom. This differs from the traditional understanding of non-pharmacological palliative care as ‘basic’...."
Tuesday, February 14, 2012
open access: PLoS Medicine: Complexity in Non-Pharmacological Caregiving Activities at the End of Life: An International Qualitative Study including Editorial Summary
including:
Editors' Summary Top
Background
End-of-life care is a major public health issue, yet despite the inevitability of death, issues related to death and dying are often taboo, and, if mentioned, are often referred to as “palliative care.” There are detailed definitions of palliative care, but in essence, the purpose of palliative care is to relieve any suffering in patients who are dying from progressive illness and to provide the best possible quality of life for both the patient and his or her family. In order to achieve this aim, both pharmacological and non-pharmacological management is necessary, with the latter taking a central role. Recently, a European Commission Seventh Framework Programme project, OPCARE9, aimed to improve the care of dying patients in Europe and beyond by optimizing research and clinical care for patients with cancer in the last days of their life, especially regarding well-being and comfort as death becomes imminent.Why Was This Study Done?
There is now a growing literature base in non-pharmacological management at the end of an individual's life, particularly in relation to psychological, ethical, and communication issues as well as family-focused and culturally appropriate care. Despite this progress, there is currently little systematic knowledge in how health workers use such non-pharmacological approaches in their efforts to maximize well-being and comfort in patients experiencing their very last days of life. Therefore, in order to advance knowledge in this important clinical area, in this study the researchers reviewed and identified the variety of non-pharmacological caregiving activities performed by different professionals in the last days and hours of life for patients with cancer (and their families) in palliative care settings in the countries that participated in OPCARE9.What Did the Researchers Do and Find?
Friday, February 10, 2012
abstract: No place like the hospital. [J Pain Symptom Manage
Source
Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215, USA. mgillick@partners.org
Abstract
The gold standard for end-of-life care is home hospice. A case is presented in which a patient dying of irreversible small bowel obstruction from metastatic cancer insisted on remaining in the acute care hospital for care when alternative sites of care, including a skilled nursing facility and residential hospice, were available to her and covered by her health insurance plan. The ethical issues raised by this case are discussed from the perspective of the patient, the clinical team, the hospital, and the insurance company. Over the past decade, hospital-based palliative care consultation and general inpatient hospice care have sought to improve the quality of dying in the hospital. To the extent that such efforts have been successful, they may result in increasing demand for the hospital as the site for terminal care in the future.Wednesday, February 08, 2012
abstract: A survey of gynecologic oncologists regarding the End-of-Life discussion: A pilot study
Results.
Response rate was 12.8%.Highlights
► A survey was sent to 1105 gynecologic oncologists to evaluate practices and attitudes regarding the end-of-life discussion
► This discussion appears to be had late
► This may contribute to patients' inability to effectively take part in her plan of care
► This discussion appears to be had late
► This may contribute to patients' inability to effectively take part in her plan of care
Monday, February 06, 2012
abstract: The Pattern of Antimicrobial Use for Palliative Care In-Patients During the Last Week of Life
Background: In terminally ill cancer patients approaching the dying phase, liberal use of antimicrobials is often viewed by palliative care experts as irrational. No previous reports have reviewed current antimicrobial use in palliative care settings in Saudi Arabia.
Objective: The objective of this study was to explore the pattern of antimicrobial use in a tertiary palliative care unit (TPCU) during the last week of patients’ life.
Methods: Medical records of all patients who died in the TPCU over a 14-month period were reviewed for demographics as well as the frequency and rationale of antimicrobial use during the patients’ last week of life. Information on antimicrobial use was obtained from a computerized pharmacy database.
Results: Of 138 patients who died with advanced cancer in the TPCU, 87 (63%) were on one or more antimicrobials during their last week of life. Antibiotics were more frequently used as compared to antifungal and antiviral agents, 64 (46.4%); 45 (32.6%); and 2 (1.5%), respectively. About one third (31.3%) of patients who received antibiotics during their last week of life were prescribed more than one antibiotic. Antimicrobials were mostly given systemically (79%) rather than topically (21%). The most common rationales for antimicrobial prescribing were oral thrush in 36 patients (25.4%), wound care in 29 patients (20.4%), and on empirical basis in 29 patients (20.4%).
Conclusions: The current practice of antimicrobial prescribing, especially for patients who are eminently dying, may need to be reviewed. Initiation of antimicrobial treatment in this group of patients should be based on clear treatment goals and desired outcomes, considering views of patients and families.
abstract: End-of-Life Care at an Academic Medical Center
"Background: End-of-life care is deemed to be poor in the United States – particularly in large teaching hospitals. Via a brief survey, we examined satisfaction with end-of-life care for those patients who died in our academic medical center from provider and family perspectives.
Methods: To assess the correlation between overall satisfaction between providers (attending, housestaff, and nurses) as well as family members for decedents who died in our hospital, we conducted a satisfaction survey regarding care in the last three days of life. The nine item survey was administered within 1 week of the patient s death to care providers and approximately 8 to 12 weeks to next of kin.
Results: There were 166 deaths examined over the four month study period. Overall satisfaction with care was 3.02 out of 4.0, and differed by respondent group (p= 0.035). Correlation between respondents was very low (range 0.02 to 0.51). The least discordance was between residents and interns (0.5), who had the lowest level of satisfaction (2.72). Housestaff and attendings had the lowest overall correlation in mean satisfaction scores (0.05). Most providers knew their patients for 24 hours or less.
Conclusions: Overall satisfaction was high, but there was discordance among different providers. Continuity of care was limited. Age and location of death alone did not significantly affect satisfaction with end-of-life care. Implications of this type of research for improving end of life care at academic centers are discussed."
Methods: To assess the correlation between overall satisfaction between providers (attending, housestaff, and nurses) as well as family members for decedents who died in our hospital, we conducted a satisfaction survey regarding care in the last three days of life. The nine item survey was administered within 1 week of the patient s death to care providers and approximately 8 to 12 weeks to next of kin.
Results: There were 166 deaths examined over the four month study period. Overall satisfaction with care was 3.02 out of 4.0, and differed by respondent group (p= 0.035). Correlation between respondents was very low (range 0.02 to 0.51). The least discordance was between residents and interns (0.5), who had the lowest level of satisfaction (2.72). Housestaff and attendings had the lowest overall correlation in mean satisfaction scores (0.05). Most providers knew their patients for 24 hours or less.
Conclusions: Overall satisfaction was high, but there was discordance among different providers. Continuity of care was limited. Age and location of death alone did not significantly affect satisfaction with end-of-life care. Implications of this type of research for improving end of life care at academic centers are discussed."
abstract: A Qualitative Study of Family Involvement in Decisions About Life Support in the Intensive Care Unit
"We explored family involvement in decisions about life support interventions in the intensive care unit study using a critical incident technique to focus on specific case exemplars contributed by participants. A total of 6 family members and 9 health care professionals were interviewed. Participants described 2 options (life support or comfort care) and values associated with options: maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, needing adjustment time, and judicious health care resource use. Barriers to involvement included not being offered alternative options; no specific trigger to initiate decision making; dominant influence of professionals’ values; and families lacking understandable information. Family members are unlikely to engage in decision making unless professionals identify the decision and address other barriers to family involvement."
Friday, January 20, 2012
Stein Kaasa (Norway): Let me show you what integrated palliative care can do - Cover Story - Issues 46 - Articles - Cancer World (open access)
"One aspect of his field particularly annoys Kaasa, and that is terminology. As far as he is concerned, it is called ‘palliative care’ or ‘palliative medicine’ and should cover the vast majority of the advanced cancer journey. But he says confusion can be spread by the use of ‘end of life care’ and ‘supportive care’. “In some cancer centres this is often about competing for resources, with some focusing on what they call earlier symptom control in ‘supportive care’, while leaving others to do the ‘end of life’. Yes, if you have a large palliative care team you can have people focusing more on early symptoms, but really this is often about a resources battle and not integrated care, and of course again it is the patients who fall into the gaps.”"
Sunday, January 15, 2012
Thursday, July 28, 2011
Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial : The Lancet Oncology
Background
Dignity therapy is a unique, individualised, short-term psychotherapy that was developed for patients (and their families) living with life-threatening or life-limiting illness. We investigated whether dignity therapy could mitigate distress or bolster the experience in patients nearing the end of their lives.
Monday, June 13, 2011
End-of-Life Care for Advanced Lung Cancer Differs Markedly Between U.S. and Ontario
Note: study on lung cancer but pertinent for all cancer patients/families
Even more important, he writes, patient preferences vary from one individual to another and these preferences are often unheard: “Quality in end-of-life care will continue to elude us if we assume that societal average preferences indicate the care individual patients want and need,” he writes.
Friday, October 08, 2010
Canadian Health Reference Guide-Patients and caregivers want more support at the end of life
New tool helps patients and families communicate their needs
Friday, May 14, 2010
Tuesday, April 27, 2010
End of life in cancer patients: drugs or words? — Ann Oncol
Note: editorial partial extract from full paper ($$)
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