Palliative and Supportive Care最新文献

{"title":"Clinical management of delirium: The response depends on the subtypes. An observational cohort study in 602 patients","authors":"C. Zipser, S. Knoepfel, P. Hayoz, M. Schubert, J. Ernst, R. von Känel, Soenke Boettger","doi":"10.1017/S1478951519000609","DOIUrl":"https://doi.org/10.1017/S1478951519000609","url":null,"abstract":"Abstract Objective The hypoactive, hyperactive, and mixed subtypes of delirium differently impact patient management and prognosis, yet the evidence remains sparse. Therefore, we examined the outcome of varying management strategies in the subtypes of delirium. Methods In this observational cohort study, 602 patients were managed for delirium over 20 days with the following strategies: supportive care alone or in combination with psychotropics, single, dual, or triple+ psychotropic regimens. Cox regression models were calculated for time to remission and benefit rates (BRs) of management strategies. Results Generally, the mixed subtype of delirium caused more severe and persistent delirium, and the hypoactive subtype was more persistent than the hyperactive subtype. The subtypes of delirium were similarly predictive for mortality (P = 0.697) and transfer to inpatient psychiatric care (P = 0.320). In the mixed subtype, overall, psychotropic drugs were administered more often (P = 0.016), and particularly triple+ regimens were administered more commonly compared to hypoactive delirium (P = 0.007). Patients on supportive care benefited most, whereas those on triple+ regimens did worst in terms of remission in all groups of hypoactive, hyperactive, and mixed subtypes (BR: 4.59, CI 2.01–10.48; BR: 4.59, CI 1.76–31.66; BR: 3.36, CI 1.73–6.52; all P < 0.05). Significance of results The mixed subtype was more persistent to management than the hypoactive and hyperactive subtypes. Delirium management remains controversial and, generally, supportive care benefited patients most. Psychopharmacological management for delirium requires careful choosing of and limiting the number of psychotropics.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"15 1","pages":"4 - 11"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86288746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between spiritual well-being and quality of life in cancer survivors","authors":"M. Yilmaz, Hatice Oner Cengiz","doi":"10.1017/S1478951519000464","DOIUrl":"https://doi.org/10.1017/S1478951519000464","url":null,"abstract":"Abstract Objective To evaluate the relationship between spiritual well-being (SpWB) and quality of life (QoL) in cancer (CA) survivors. Methods The current study was conducted in the oncology center at a university hospital in Central Anatolia/Turkey. In this study, a descriptive cross-sectional survey design was used. The data collected included: a questionnaire form, the current study was conducted in the oncology center at a university hospital in Central Anatolia/Turkey. In this study, a descriptive cross-sectional survey design was used. SpWB was assessed by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, version 4 (FACIT-Sp12, v. 4), including Meaning, Peace, and Faith subscales. The QoL was evaluated using the Functional Assessment of Cancer Therapy-General scale (FACT-G, v. 4). The results were analyzed using descriptive statistics, Pearson correlations, independent sample t-test, Kruskal-Wallis, and Mann-Whitney U test. Results One hundred fifty patients participated in this study: 61.30% female, 78% 45 years of age or older, 94.70% married, 46% had finished, and 69% had gastrointestinal tract CA. The mean age was 53.48 (SD = 9.43). The majority of participants (96.7%) endorsed “a force pushing them a will to live” while 59.3% supported “the power of relationships with others.” There was a positive, strong correlation between overall QoL and SpWB (r = 0.619, p < 0.01). The Meaning dimensions of SpWB with Functional Well-Being (FWB) and overall QoL (r = 0.512; 0.595, p < 0.000 respectively), Peace with Emotional Well-Being (EWB) and FWB (r = 0.598; 0.540, p < 0.000 respectively) dimensions of FACT-G and overall QoL (r = 0.609, p < 0.001) were strong correlated. Faith and QoL were not significantly correlated. Significance of results This study demonstrates that SpWB positively contributed to the QoL of CA survivors. SpWB is not necessarily limited to any specific types of beliefs or practices. For some people, faith in self, others and/or God constitutes, in large part, the meaning, purpose, and fulfillment they find in life.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"503 1","pages":"55 - 62"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77076503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PAX volume 17 issue 6 Cover and Front matter","authors":"","doi":"10.1017/s1478951519001093","DOIUrl":"https://doi.org/10.1017/s1478951519001093","url":null,"abstract":"","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"39 1","pages":"f1 - f4"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75412939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aiding end-of-life medical decision-making: A Cardinal Issue Perspective","authors":"Haoyang Yan, Stephanie K. Kukora, C. Arslanian-Engoren, P. Deldin, K. Pituch, J. Yates","doi":"10.1017/S1478951519000981","DOIUrl":"https://doi.org/10.1017/S1478951519000981","url":null,"abstract":"","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"19 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2019-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82149377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between palliative care and the rate of advanced care planning: A systematic review","authors":"S. Koffler, Yishai Mintzker, A. Shai","doi":"10.1017/S1478951519001068","DOIUrl":"https://doi.org/10.1017/S1478951519001068","url":null,"abstract":"Abstract Objective Advanced care planning (ACP) is central to patients' dignity and autonomy; however, in many countries it is underutilized. Studies that tested the effects of palliative care (PC) often included the rate of documented ACP as a secondary end point. We aimed to assess the contribution of PC to the rate of ACP among terminally ill patients by systematically reviewing relevant clinical trials. Method PUBMED and “Cochrane trials” databases were screened for clinical trials published until October 2017 that compared the addition of PC to standard treatment and that had ACP as a primary or a secondary end point. Studies were assessed for validity by three investigators using the Cochrane Collaboration tool and the ROBINS-I tool for randomized controlled trials (RCTs) and for cohort studies, respectively. Results Twenty-six trials with 37,924 patients were included. Four were RCTs, nine were cohort studies, and 12 were cross-sectional studies. Randomized trials had the lowest risk of bias. There was a positive correlation between the addition of PC and ACP in 25 studies, among them four randomized trials. Significance of results In this systematic review, PC was associated with improvement in the rate of ACP. Understanding the significant effect of PC on the completion of ACP is an additional emphasis on the importance of this treatment among terminally ill patients.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"23 1","pages":"589 - 601"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80406314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors related to advance care planning among older African American women: Age, medication, and acute care visits","authors":"Jung Kwak, J. Ellis","doi":"10.1017/S1478951519001007","DOIUrl":"https://doi.org/10.1017/S1478951519001007","url":null,"abstract":"Abstract Objectives Advance care planning (ACP) is linked with high-quality clinical outcomes at the end of life. However, ACP engagement is lower among African Americans than among Whites. In this study, we sought to identify correlates of ACP among African American women with multiple chronic conditions for two reasons: (1) African American women with multiple chronic conditions have high risks for serious illnesses, more intensive treatments, and circumstances that may require substitutes' decision-making and (2) identifying correlates of ACP among African American women can help us identify important characteristics to inform ACP outreach and interventions for this group. Methods A cross-sectional survey was conducted with 116 African American women aged ≥50 years who were recruited from the central area of a mid-western city. Results On average, participants were 64 years old (SD = 9.42). The majority were not married (78%), had less than a college education (50%), and had an annual income of $15,000 (54%). Their mean numbers of chronic conditions and prescribed medications were 3.31 (SD = 1.25) and 8.75 (SD = 4.42), respectively. Fifty-nine per cent reported having talked with someone about their preferences (informal ACP); only 30% had completed a living will or a power of attorney for healthcare (formal ACP). Logistic regression showed that age, the number of hospitalizations or emergency department visits, and the number of prescription medications were significantly correlated with both informal and formal ACP; other demographic and psychosocial characteristics (the knowledge of ACP, self-efficacy, and trust in the medical system) were not. Significance of results Results of this study suggest a need for targeted, culturally sensitive outpatient ACP education to promote ACP engagement in older African American women, taking into account age, the severity of chronic conditions, and levels of medication management.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"57 1","pages":"413 - 418"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73080440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehension and acceptance of the Meaning-Centered Psychotherapy with a Puerto Rican patient diagnosed with advanced cancer: A case study","authors":"N. Torres-Blasco, Eida M. Castro, Iris Crespo-Martín, K. Gonzalez, Emely Pérez Ramírez, Olga Garduño, R. Costas-Muñiz","doi":"10.1017/S1478951519000567","DOIUrl":"https://doi.org/10.1017/S1478951519000567","url":null,"abstract":"Abstract Background Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention that aims to improve existential and spiritual well-being in patients with advanced cancer. To validate it, several efficacy studies with predominantly non-Hispanic white patients have been done. Puerto Ricans residing on the island are a largely overlooked segment of the US Latinx population. They have a strong national identity and are embedded in a collectivist culture which shares the Spanish language, cultural traditions, and an emphasis on familism, a cultural factor that values the role of the family in ensuring the well-being of its members. Objective The purpose of this study is to present a case study focused on a Puerto Rican advanced cancer patient who underwent MCP to assess the comprehension and acceptance of the MCP intervention. Method We used a mixed-methods study design that included the taking of ethnographic notes, and pre- and post-test assessments of the scores the patient received on all the measures (using validated scales). The ethnographic notes were analyzed to determine the participant's comprehension and acceptance of the MCP intervention. Content analysis was performed on the ethnographic notes by three independent coders using a deductive coding approach. Pre- and post-interview assessments were conducted to explore changes in distress, spiritual well-being, and self-perceived quality of life. Results A Latino patient with stage III cancer, low income, and low literacy skills showed low comprehension of the concepts of meaning, the finite, legacy, and moderate comprehension and acceptance of the concepts of the search for hope, purpose in life, connecting with life, courage, life's limitations, and sources of meaning. However, the patient showed high comprehension of death and dying (i.e., meaningful death). The patient showed low acceptance of death and dying concepts and high acceptance of the integration of family members into the therapy. Significance of Results Additional studies are needed to address cultural themes and to improve the comprehensibility and acceptance of the manual's content and the central MCP concepts. The findings suggest that MCP has the potential of being a feasible form of psychotherapy for Latinx patients suffering from distress, low spiritual well-being, and low self-perceived QOL.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"46 1","pages":"103 - 109"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72854581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting","authors":"Suhair Bandeali, Amanda Roze des Ordons, A. Sinnarajah","doi":"10.1017/S1478951519001020","DOIUrl":"https://doi.org/10.1017/S1478951519001020","url":null,"abstract":"Abstract Objective The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. Method We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: • Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium • Psychological: depression, anxiety, prognosis, and dignity • Social: caregiver burden, isolation, and financial • Spiritual: spiritual distress Results The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. Significance of results The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"55 1","pages":"513 - 518"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88863466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience of nurses who work with children with palliative care needs: A mixed-method systematic review","authors":"Maha Atout","doi":"10.1017/S1478951519000956","DOIUrl":"https://doi.org/10.1017/S1478951519000956","url":null,"abstract":"Abstract Objective The importance of palliative care education for nurses has been recognized worldwide. The study aims to explore the experiences of nurses working with children with palliative care needs and to identify any related educational needs. Methods The electronic databases of CINAHL, Cochrane, PubMed, OVID, Social Care Online, Web of Science, Scopus, and ProQuest were searched for the period 2000–2015. Results Finding revealed that working with children with palliative care needs is an emotionally struggling job for nurses, especially when they try to manage the transition of pediatric patients from curative to palliative care. Staffing level and time constraints comprise a major obstacle in pediatric palliative care. Focusing on invasive treatment and technology in spite of the feelings that it will not improve patients' health status intensifies the feeling of guilt and helplessness for nurses. Finally, nurses asserted the importance of receiving pediatric palliative care education, especially how to communicate with children with palliative care needs and their families. Significance of results Further research is recommended with regard to nurses' experience in communication with children with palliative care needs. Nursing education in pediatric palliative care is significantly important, especially how to communicate with children with palliative care needs and their families.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"14 1","pages":"473 - 485"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76996574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translation, cultural adaptation, and validation of the Brazilian Portuguese version of the End-of-Life Professional Caregiver Survey","authors":"A. C. M. Garcia, Vivian Marina Calixto Damasceno Spineli, Aline Helena Appoloni Eduardo, E. Meireles, Guilherme Antonio Moreira de Barros, M. Lazenby","doi":"10.1017/S1478951519000993","DOIUrl":"https://doi.org/10.1017/S1478951519000993","url":null,"abstract":"Abstract Objectives The aim of this study was to translate, culturally adapt, and psychometrically evaluate the Brazilian version of the “End-of-Life Professional Caregiver Survey” (BR-EPCS). Method This is an observational cross-sectional study. The sample was composed of 285 Brazilian healthcare professionals who work or worked in the palliative care area. A minimum number of 280 participants were established, following the recommendation of 10 subjects for each instrument item. The European Organisation for Research and Treatment of Cancer — Quality of Life Group Translation Procedure protocol was used for the translation and the cultural adaptation. For the precise/reliable evaluation of factors measured by the BR-EPCS, Cronbach's alpha (α) and composite reliability coefficients were used. The factorial analyses were made by means of the exploratory structural equation modeling methods and confirmatory factor analysis. We have conducted a multiple linear regression analysis to evaluate the sociodemographic variables' capabilities in the result prediction measured by BR-EPCS factors. Results The factorial analysis showed the relevance of two factors: Factor 1 — “Given care effectiveness” (18 items; Cronbach's α = 0.94; Composite Reliability = 0.95) and Factor 2 — “Mourning and ethical and cultural values” (10 items; Cronbach's α = 0.89; Composite Reliability = 0.88). Multiple linear regression analyses revealed that the working time, sex, palliative care training, and its own advance directives are predictors of the constructs assessed by the BR-EPCS. Significance of results The BR-EPCS is a reliable, valid, and culturally appropriate tool to identify the educational needs of healthcare professionals who work with palliative care. This instrument can be used for educational and research reasons.","PeriodicalId":19953,"journal":{"name":"Palliative and Supportive Care","volume":"78 1","pages":"569 - 574"},"PeriodicalIF":0.0,"publicationDate":"2019-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83649085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}