PROGRESS IN PALLIATIVE CARE最新文献

{"title":"Integrating palliative care into primary health care: Indian perspectives","authors":"Radhika R. Pai, Malathi G. Nayak, Anita Jesline Serrao, N. Salins","doi":"10.1080/09699260.2023.2241799","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241799","url":null,"abstract":"Access to palliative care is essential in primary healthcare as most patients and families prefer end-of-life care at home. However, integrating palliative care into the community is often lacking, disrupting the continuity of care. In a low-middle-income country like India, palliative care is usually provided in tertiary and secondary hospitals. Primary palliative care is sporadically offered in some parts of India, like Kerala, through a neighbourhood network of palliative care (NNPC) programmes. The availability of trained providers, funding, and awareness, limits the capacity to provide primary palliative care. It leads to people accessing care at their end of life in acute hospitals, receiving unnecessary medical interventions, and diminishing their quality of dying. The need for developing palliative care in the community in a low-middle-income country like India is explicated here.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"282 - 286"},"PeriodicalIF":1.7,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44293371","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":"Volunteer experiences at a hospice for homeless individuals during the COVID-19 pandemic","authors":"A. Kamimura, S. Panahi, Ashley Kang, K. C. Whitesitt, Jeanie Ashby, Jill Olmsted","doi":"10.1080/09699260.2023.2241791","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241791","url":null,"abstract":"Context Volunteers provide important social support for homeless people. While motivations of the volunteer population for homeless people have been studied, little is known about volunteers for a hospice targeting the homeless population. Objectives The purpose of this study is to describe volunteer experiences and motivation at a hospice for homeless people during the COVID-19 pandemic. Methods This study was conducted at a hospice for homeless individuals in Fall 2021. Data were collected by six virtual focus groups in November and December 2021. There were 21 participants. The recordings of the focus groups were automatically transcribed via ZOOM. The data were analyzed based on themes. Results This study has highlighted three main findings. First, honoring a loved one and being engaged in the community were two main reasons individuals began volunteering at the hospice center. Second, volunteers faced many challenges during the COVID-19 pandemic, including a slow start, increased use of technology, and constant change in volunteers’ responsibilities due to safety reasons. During this time however, volunteers felt much support from the program staff. Third, interactions with staff, other volunteers and residents were the main reasons driving volunteer motivation. Conclusions This project examined the under-studied subject of volunteers’ experiences at a hospice for homeless people and provided insight in this topic. While the COVID-19 pandemic affected volunteering at a hospice for homeless people, support from the program staff and leadership helped sustain volunteer motivation.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"1 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44898577","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":"Exploring the awareness, knowledge and perceptions of palliative care at end-of-life in a Canadian population","authors":"Priya Patel, S. Koppikar, Lily Spoozak, L. Lyons","doi":"10.1080/09699260.2023.2241789","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241789","url":null,"abstract":"Background The role of palliative care (PC) in chronic disease and end-of-life (EOL) management is rapidly evolving. However, studies globally have demonstrated limited public knowledge and awareness of PC with several misconceptions. Objective The purpose was to expand upon previous Canadian studies by providing more current and detailed information about the awareness, knowledge and perceptions of PC in EOL management. Additionally, the reliability of self-reported PC knowledge was explored. Methods A cross-sectional study using an 8-item questionnaire was conducted at an urban medical centre with 100 adults. Descriptive statistics and Chi-square tests were used for analyses. Results Ninety-one participants had heard of PC, while 58 reported being knowledgeable of PC services. Females were significantly more knowledgeable than males (p < 0.05). Most participants knew that PC improves a patient’s quality of life (n = 71), would not shorten life in a dying individual (n = 71) and can be provided in locations outside of the hospital (n = 72). Many indicated that involving PC services would not make them feel like they were giving up hope. There was less awareness around when to involve PC services, as there were mixed answers to whether PC is only needed if someone is dying from an illness. Two-thirds of participants who reported being knowledgeable of PC answered at least 75% of questions correctly. Conclusion Participants were quite aware and knowledgeable of PC but would benefit from education about the PC role in both chronic disease and EOL management. Self-reported knowledge was a fairly reliable indicator of true knowledge in this study.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47000699","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":"A comparison of symptom management and utilization of specialist palliative care in the early COVID-19 pandemic: A multi-site retrospective chart review","authors":"Madelaine Baetz-Dougan, J. Guan, B. Henry, K. Stilos, Desmond D. Leung, Niren Shetty, Shruti Gupta, A. Chakraborty","doi":"10.1080/09699260.2023.2241784","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241784","url":null,"abstract":"Background: COVID-19 is associated with high rates of morbidity and mortality. Previous work has described symptom management provided by specialists in palliative care for COVID-19 patients. However, there is a paucity of literature describing primary level palliative care provided by general internal medicine teams or reasons for referral to specialists. Objective: Our aim was to describe and compare the following outcomes for patients dying of COVID-19: (1) symptom management by acute care providers and palliative care specialists, and (2) utilization of palliative care consultation across two acute care hospitals in Toronto, Ontario during the onset of the COVID-19 pandemic. Methods: We undertook a retrospective chart review of 45 adult inpatients diagnosed with COVID-19 between 23 January 2020 to 19 May 2020 who died, and/or those who had a palliative care consultation. Findings: Forty-one of the 45 patients died. Common symptoms were shortness of breath and agitation. For these symptoms, pharmacologic management was not significantly different for patients seen by palliative care compared to those without consultation. Most consultations were for end-of-life care. There were significantly more palliative care consults for COVID-19 patients at one hospital (P=.001). Conclusion: The findings highlight the significant discrepancy in involvement of specialist palliative care between settings. More research is needed to validate the initial findings from this small sample size, understand the needs of palliative care providers in this setting, and appreciate the factors influencing consultation.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46674142","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":"Differences in patients accessing inpatient versus outpatient palliative care at time of referral at a cancer centre","authors":"David Marco, A. Collins, B. Le, J. Philip","doi":"10.1080/09699260.2023.2241798","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241798","url":null,"abstract":"Outpatient palliative care clinics are a new and developing area of service delivery that can respond to increasing demand and facilitate earlier contact in the illness trajectory. Work is needed to standardise the criteria for referral to outpatient palliative care services and clarify which patients are likely to benefit the most from this mode of support. This study aimed to describe the demographic, clinical and symptom profile, and survival of patients referred to a newly established hospital-based integrated palliative care program. Comparisons were made between patients initially seen as outpatients versus those seen as inpatients. A retrospective population was identified from routinely collected hospital admitted inpatient and ambulatory databases comprising adult cancer patients receiving a new referral to the service during a 6-month period. Patients were grouped into two cohorts according to the setting of their first palliative care assessment and followed to death or study censor date. During the study period, 473 new referrals were made comprising 229 (48%) patients initially seen as outpatients and 244 (52%) initially seen as inpatients. The outpatient cohort had higher performance status, experienced higher symptom burden, lived longer, had fewer inpatient admissions, and received earlier referral to palliative care resulting in greater palliative care involvement up to their death (all p < .05). Early palliative care can be effectively delivered by an outpatient palliative care service for cancer patients who are experiencing symptom burden but are otherwise functional. These cases lived longer and had fewer subsequent inpatient visits, demonstrating the preliminary effectiveness of this integrated service.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"293 - 299"},"PeriodicalIF":1.7,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43978192","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":"Nurses’ challenges in the end-of-life care of patients with COVID-19: A qualitative study","authors":"Hadiseh Monadi Ziarat, M. Mardani-Hamooleh, N. Seyedfatemi, Akram Salamat","doi":"10.1080/09699260.2023.2241785","DOIUrl":"https://doi.org/10.1080/09699260.2023.2241785","url":null,"abstract":"The coronavirus disease 2019 (COVID-19) pandemic has brought rapid changes in end-of-life care for nurses and patients. The aim of this study was to explain the Iranian nurses’ perception of challenges in providing end-of-life care for patients with COVID-19. The present study is a qualitative research with content analysis approach. A total of 32 nurses participated in this study. Semi-structural and individual interviews were conducted. Nurses’ narratives indicated that, the challenges of end-of-life care of patients with COVID-19 can be classified in two categories of undesirable care and problems with family support. The category of undesirable care had two subcategories of low quality care and futile care. The category of problems with family support also had two subcategories of lack of family support at the time of hospitalization and lack of a support system for family after the patient's death. The health system, and in particular nursing managers, should strive to formulate clear rules and regulations and design the necessary protocols that are effective in addressing the nurses’ challenges in end-of-life care of COVID-19 patient.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"287 - 292"},"PeriodicalIF":1.7,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47671976","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":"Thyroid Dysfunction after Atezolizumab and Bevacizumab Is Associated with Favorable Outcomes in Hepatocellular Carcinoma.","authors":"Young Shin Song, Hannah Yang, Beodeul Kang, Jaekyung Cheon, Ilhwan Kim, Hyeyeong Kim, Won Suk Lee, Yun Beom Sang, Sanghoon Jung, Ho Yeong Lim, Vincent E Gaillard, Chan Kim, Hong Jae Chon","doi":"10.1159/000531182","DOIUrl":"10.1159/000531182","url":null,"abstract":"<p><strong>Introduction: </strong>Atezolizumab and bevacizumab (Ate/Bev) combination has become the new first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). Although several studies reported thyroid dysfunction after treatment with immune checkpoint inhibitors, the clinical and immunological significance of thyroid dysfunction in patients treated with Ate/Bev has not been comprehensively addressed. We aimed to comprehensively evaluate the clinical and immunological implications of thyroid dysfunction in unresectable HCC patients treated with Ate/Bev.</p><p><strong>Methods: </strong>We enrolled 208 patients with unresectable HCC treated with Ate/Bev from three Korean cancer centers. Thyroid adverse events (AEs) were reviewed, and cytokines and T cells in the blood samples were analyzed at baseline. For external validation, we analyzed clinical outcomes according to thyroid AEs in patients treated with Ate/Bev in the IMbrave150 study.</p><p><strong>Results: </strong>Forty-one (19.7%) out of 208 patients experienced thyroid dysfunction (hypothyroidism [17.3%] and thyrotoxicosis [5.8%]) after Ate/Bev treatment. Median time to onset of hypothyroidism and thyrotoxicosis after Ate/Bev treatment was 3.5 and 1.3 months, respectively. Patients with thyroid AEs demonstrated significantly better progression-free survival, overall survival, and objective response rate than those without thyroid AEs. These findings were still consistent even after adjusting for confounding factors. Furthermore, favorable survival outcomes in patients with thyroid AEs were also validated in a cohort of IMbrave150 patients. While patients with thyrotoxicosis showed a significantly lower level of baseline IL-6, those with hypothyroidism did not show significant differences in circulating cytokine levels and CD8⁺ T-cell fractions.</p><p><strong>Conclusions: </strong>A fraction of patients with HCC treated with Ate/Bev experienced thyroid dysfunction, and the development of thyroid AEs was associated with favorable clinical outcomes.</p>","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"15 1","pages":"89-98"},"PeriodicalIF":13.8,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87550304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auriculotherapy to manage chemotherapy-induced nausea and vomiting in patients with cancer: a systematic review","authors":"E. Paiva, Si-jia Zhu, Yuan Chi, Ramon A. Oliveira, C. Moura, Ana Cláudia M. Garcia","doi":"10.1080/09699260.2022.2152168","DOIUrl":"https://doi.org/10.1080/09699260.2022.2152168","url":null,"abstract":"Objective To assess the effects of auriculotherapy for the management of CINV in cancer patients. Methods This is a systematic review of randomized controlled trials (RCTs). We searched MEDLINE via PubMed, AMED, Biblio Auriculo, Embase, CINAHL, CENTRAL, BVS, MTCI Américas, Web of Science, Scopus, PEDro, CNKI, CBMdisc, and CSJD-VIP databases up to September 2021 with no language restrictions. Results We included 25 studies with a total of 2,167 randomized participants. The results of the included studies suggest positive effects of auriculotherapy for the control of CINV, however 92% studies presented a high risk of bias overall. In the included studies, the most used auricular acupoints in the studies were the stomach (CO4) (n = 24, 96%), shenmen (TF4) (n = 23, 92%), sympathetic nerve (AH6a) (n = 15, 60%), spleen (CO13) (n = 14, 56%), liver (CO12) (n = 11, 44%), subcortex (AT4) (n = 10, 40%), and cardia (CO3) (n = 9, 36%). Conclusions It was not possible to assess the effectiveness of auriculotherapy for the management of CINV due to the great heterogeneity of the studies regarding the form of evaluating the outcome, the application of auriculotherapy, and the high risk of bias. It is suggested that robust clinical trials be conducted and reported according to the STRICTA guidelines.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"100 - 110"},"PeriodicalIF":1.7,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46931329","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":"Referral patterns and consultation locations for a novel palliative care telehealth service","authors":"Taylan Gurgenci, Luke Nicholls, Sangitha Mensingh, A. Broadbent, Graham Grove","doi":"10.1080/09699260.2022.2160084","DOIUrl":"https://doi.org/10.1080/09699260.2022.2160084","url":null,"abstract":"Background\u0000 The optimal location to conduct telehealth consultations for rural Australian palliative patients was unclear prior to starting a novel palliative telehealth service in Queensland. The present study sought to collect data which may suggest the best location for such consultations so that future service provision can be planned accordingly. \u0000 Methods\u0000 A retrospective review of the referral patterns and demographic data between March 2020 and November 2020 was undertaken with a focus on the number of referrals, location of consultations, and the source of referrals. \u0000 Results\u0000 153 referrals resulted in 526 unique consultations. All referrals in the first month came from the local public hospital. After 4 months, public hospital referrals and private family doctor referrals accounted for 30% and 50% respectively. The proportion of telehealth consultations delivered in the patient’s home increased throughout the eight-month period. There was no obvious relationship between referral source and consultation location. \u0000 Conclusion\u0000 The patient’s home was the preferred location for all specialist telehealth care and patient preference was the main determinant of consult location. Further research should involve qualitative analysis of these factors to optimize the delivery of this service and the design of other similar services.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"95 - 99"},"PeriodicalIF":1.7,"publicationDate":"2023-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47480543","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":"Palliative care roles and responsibilities of mesothelioma clinical nurse specialists in the UK","authors":"C. Gardiner, Madeleine Harrison, Sarah Hargreaves, B. Taylor","doi":"10.1080/09699260.2022.2158286","DOIUrl":"https://doi.org/10.1080/09699260.2022.2158286","url":null,"abstract":"Mesothelioma is a rare incurable cancer caused by exposure to asbestos. Patients with mesothelioma have palliative care needs throughout the course of their illness, from diagnosis to the end of life. Mesothelioma clinical nurse specialists (CNSs) are central to providing care for patients with mesothelioma, but little is known about their role in providing palliative care. The aim of this study was to explore the views of mesothelioma patients and CNSs on the role of palliative care in mesothelioma, and explore which aspects of palliative care are provided by CNS’s. The cross-sectional study included: (1) Secondary analysis of existing data from 510 mesothelioma patients who completed a 2019 survey of patient experiences and; (2) A survey of 23 Mesothelioma UK CNS’s exploring their role in delivering palliative care. Data were analysed using descriptive statistics. Results indicated that 63% of mesothelioma patients did not feel that palliative care was needed at the time of survey completion. Data from the CNS survey showed that over 95% of CNS’s felt they had a role in providing palliative care, and all CNSs had received some prior training or education in palliative care. Confidence in delivering palliative care was generally high with the mean score of 26.52 (SD = 2.68) out of a maximum of 30. CNS’s are highly skilled at providing palliative care in mesothelioma, providing both specialist and generalist palliative care. However, work is required to encourage patients and their families to engage with palliative care earlier in the disease trajectory.","PeriodicalId":45106,"journal":{"name":"PROGRESS IN PALLIATIVE CARE","volume":"31 1","pages":"73 - 79"},"PeriodicalIF":1.7,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47252232","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}