{"title":"Hospice and Palliative Care for Patients in the Intensive Care Unit: Current Status in Countries Other than Korea.","authors":"Minkyu Jung","doi":"10.14475/jhpc.2023.26.1.22","DOIUrl":"https://doi.org/10.14475/jhpc.2023.26.1.22","url":null,"abstract":"<p><p>Although most patients prefer dying at home, patients whose condition rapidly becomes critical need care in the intensive care unit (ICU), and it is rare for them to die at home with their families. Therefore, interest in hospice and palliative care for patients in the ICU is increasing. Hospice and palliative care (PC) is necessary for all patients with life-threatening diseases. The following patients need palliative care in the ICU: patients with chronic critical illnesses who need tracheostomy, percutaneous gastrostomy tube, and extracorporeal life support; patients aged 80 years or older; stage 4 cancer patients; patients with specific acute diseases with a poor prognosis (e.g., anoxic brain injury and intracerebral hemorrhage requiring mechanical ventilation); and patients for whom the attending physician expects a poor prognosis. There are two PC models-a consultative model and an integrative model-in the ICU setting. Since these two models have advantages and disadvantages, it is necessary to apply the model that best fits each hospital's circumstances. Furthermore, interdisciplinary decision-making between the ICU care team and PC specialists should be strengthened to increase the provision of hospice and palliative care services for patients expected to have poor outcomes and their families.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"26 1","pages":"22-25"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cd/7f/jhpc-26-1-22.PMC10519717.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161114","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":"Prediction of Survival in Patients with Advanced Cancer: A Narrative Review and Future Research Priorities.","authors":"Yusuke Hiratsuka, Jun Hamano, Masanori Mori, Isseki Maeda, Tatsuya Morita, Sang-Yeon Suh","doi":"10.14475/jhpc.2023.26.1.1","DOIUrl":"https://doi.org/10.14475/jhpc.2023.26.1.1","url":null,"abstract":"<p><p>This paper aimed to summarize the current situation of prognostication for patients with an expected survival of weeks or months, and to clarify future research priorities. Prognostic information is essential for patients, their families, and medical professionals to make end-of-life decisions. The clinician's prediction of survival is often used, but this may be inaccurate and optimistic. Many prognostic tools, such as the Palliative Performance Scale, Palliative Prognostic Index, Palliative Prognostic Score, and Prognosis in Palliative Care Study, have been developed and validated to reduce the inaccuracy of the clinician's prediction of survival. To date, there is no consensus on the most appropriate method of comparing tools that use different formats to predict survival. Therefore, the feasibility of using prognostic scales in clinical practice and the information wanted by the end users can determine the appropriate prognostic tool to use. We propose four major themes for further prognostication research: (1) functional prognosis, (2) outcomes of prognostic communication, (3) artificial intelligence, and (4) education for clinicians.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"26 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/18/jhpc-26-1-1.PMC10519719.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41142980","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":"Treatment of Opioid Withdrawal Syndrome Triggered by Oxycodone/Naloxone with Dexmedetomidine.","authors":"Se-Il Go, Jung Hoon Kim, Jung Hun Kang","doi":"10.14475/jhpc.2023.26.1.18","DOIUrl":"10.14475/jhpc.2023.26.1.18","url":null,"abstract":"<p><p>The combination of oxycodone and naloxone is useful for cancer pain management. Naloxone, as a pure opioid antagonist, cannot be used simultaneously with opioids. However, owing to its low bioavailability, it can be used in an oral composite formulation. We present the case of a 55-year-old man with gastric cancer who experienced severe opioid withdrawal syndrome (OWS) triggered by oxycodone/naloxone that was successfully managed with dexmedetomidine. He had been in a stable condition on intravenous morphine to alleviate cancer pain. Intravenous morphine was switched to oral oxycodone/naloxone for discharge from the hospital. The patient suddenly developed restlessness, heartburn, and violent behavior 30 minutes after taking oxycodone/naloxone. We attempted sedation with midazolam and propofol, but paradoxical agitation and desaturation occurred. Next, we tried dexmedetomidine and the patient showed a decreased heart rate and reduced agitation. The patient was eventually stabilized by increasing the dose of dexmedetomidine. This report informs clinicians of the possibility of OWS when switching from opioids to oxycodone/naloxone, which can be overcome with the appropriate use of sedatives and dexmedetomidine depending on the patient's condition.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"26 1","pages":"18-21"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/b1/jhpc-26-1-18.PMC10519718.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180680","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}
Yu Mi Oh, Yoon Na Kang, Soo Jung Han, Jeong Hye Kim
{"title":"Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment.","authors":"Yu Mi Oh, Yoon Na Kang, Soo Jung Han, Jeong Hye Kim","doi":"10.14475/jhpc.2023.26.1.7","DOIUrl":"https://doi.org/10.14475/jhpc.2023.26.1.7","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs).</p><p><strong>Methods: </strong>We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021.</p><p><strong>Results: </strong>Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids.</p><p><strong>Conclusion: </strong>Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"26 1","pages":"7-17"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9f/25/jhpc-26-1-7.PMC10519720.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41177651","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":"Factors Affecting Psychological Burnout in Nurses Caring for Terminal Cancer Patients.","authors":"Na-Ri Seo, Hyun-E Yeom","doi":"10.14475/jhpc.2022.25.4.159","DOIUrl":"https://doi.org/10.14475/jhpc.2022.25.4.159","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the impacts of end-of-life care competency and ethical dilemmas on psychological burnout in nurses who care for terminal cancer patients.</p><p><strong>Methods: </strong>A cross-sectional study of 160 nurses who cared for terminal cancer patients was conducted. The participants were recruited from the hospice-palliative care wards, hematology or oncology wards, or intensive care units of three general hospitals in a single metropolitan area. Data were collected using a self-administered survey to assess end-of-life care competency, ethical dilemmas, psychological burnout, and general sociodemographic characteristics. Data were analyzed using descriptive statistics, the independent t-test, analysis of variance, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows (version 26.0).</p><p><strong>Results: </strong>Psychological burnout was significantly correlated with end-of-life care competency (r=-0.23, P=0.003) but not with ethical dilemmas. The results of the hierarchical linear regression analysis indicated that end-of-life care competency (β=-0.280, P=0.010) and ethical dilemmas (β=0.275, P=0.037) were significant predictors of psychological burnout, after adjusting for age, religious status, clinical experience, and unit type.</p><p><strong>Conclusion: </strong>The current study's findings demonstrate that end-of-life care competency and ethical dilemmas are crucial factors that affect psychological burnout in nurses who care for terminal cancer patients. Substantive education programs must be developed to improve nurses' competencies in end-of-life care and ethical dilemmas to decrease psychological burnout.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"159-168"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/36/92/jhpc-25-4-159.PMC10179995.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177850","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":"Influence of Spirituality and Job Satisfaction on the Compassion Competence of Hospice Nurses.","authors":"Su-Jeong Lee, Hyun-E Yeom","doi":"10.14475/jhpc.2022.25.4.169","DOIUrl":"https://doi.org/10.14475/jhpc.2022.25.4.169","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to examine the influence of spirituality and job satisfaction on the compassion competence of hospice nurses.</p><p><strong>Methods: </strong>This was a cross-sectional study of 118 hospice nurses from 16 hospitals in Daejeon, Chungcheong Province, and Jeolla Province. A self-administered survey was conducted using a structured questionnaire including the Spirituality Scale, Index of Work Satisfaction, the Compassion Competence Scale for Nurses, and general socio-demographic information. The data were analyzed using descriptive statistics, the t-test, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows version 26.0.</p><p><strong>Results: </strong>Compassion competence was correlated with spirituality (r=0.66, P<0.001) and job satisfaction (r=0.52, P<0.001), and spirituality was correlated with job satisfaction (r=0.44, P<0.001). Spirituality (β=0.513, P<0.001) and job satisfaction (β=0.273, P<0.001) were significant factors affecting the compassion competence of hospice nurses, after adjusting for the sociodemographic and work-related covariates. The step-by-step results from hierarchical linear regression analysis also indicated that spirituality had a stronger impact than job satisfaction on compassion competence.</p><p><strong>Conclusion: </strong>Our findings demonstrate the importance of spirituality, which plays a role in guiding the compassion competence of hospice nurses. It is necessary to support the spirituality and job satisfaction of hospice nurses, which could facilitate their compassion competence and thereby contribute to improving the quality of hospice and palliative care.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"169-177"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/e2/jhpc-25-4-169.PMC10179992.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171073","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":"Knowledge, Experience, and Attitudes of Nurses at Long-Term Care Hospitals regarding Advance Directives.","authors":"Go Eun Park, Nae Young Lee","doi":"10.14475/jhpc.2022.25.4.139","DOIUrl":"https://doi.org/10.14475/jhpc.2022.25.4.139","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to promote awareness of the need for advance directives (ADs) and to provide baseline data for the development of a nurse training program about ADs.</p><p><strong>Methods: </strong>Nurses at eight long-term care hospitals in Busan and South Gyeongsang Province (N=143) were recruited using the random sampling method from December 2018 to January 2019. Data were obtained using a structured self-reported questionnaire to assess their knowledge, experience, and attitudes regarding ADs. Data were analyzed in SPSS 22.0 using descriptive statistics, the t-test, analysis of variance, the Scheffé test, Pearson's correlation coefficient, and stepwise multiple regression analysis.</p><p><strong>Results: </strong>The mean scores were 7.79±1.39 points for knowledge, 1.92±2.00 points for experience, and 2.80±0.24 points for attitudes regarding ADs. Knowledge and experience (r=0.32, P<0.001) had a positive correlation with knowledge and attitudes (r=0.17, P=0.39).</p><p><strong>Conclusion: </strong>According to the results, nurses generally had a high level of knowledge regarding ADs, which resulted in a positive attitude toward ADs. However, they had little experience with ADs. Therefore, nurses' must develop both direct and indirect experience with ADs using a practical training program to strengthen their clinical competency regarding ADs.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"139-149"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/01/jhpc-25-4-139.PMC10179997.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171071","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":"Impact of COVID-19 on the End-of-Life Care of Cancer Patients Who Died in a Korean Tertiary Hospital: A Retrospective Study.","authors":"Jeongmi Shin, Yejin Kim, Shin Hye Yoo, Jin-Ah Sim, Bhumsuk Keam","doi":"10.14475/jhpc.2022.25.4.150","DOIUrl":"10.14475/jhpc.2022.25.4.150","url":null,"abstract":"<p><strong>Purpose: </strong>Social distancing and strict visitor restrictions at hospitals have been national policies since the onset of the coronavirus disease 2019 (COVID-19) pandemic. This has challenged the concept of a good death in comfort with the opportunity to say goodbye. Little is known about how these measures have influenced end-of-life (EOL) care among cancer patients who die in acute care hospitals. This study examined changes in the EOL care of cancer patients during the COVID-19 pandemic.</p><p><strong>Methods: </strong>We retrospectively analyzed 1,456 adult cancer patients who died in 2019 (n=752) and 2020 (n=704) at a tertiary hospital. Data on EOL care-symptom control and comfort care in an imminently dying state, preparation for death, place of death, and aggressive care in the last month-were reviewed.</p><p><strong>Results: </strong>The 1,456 patients had a median age of 67 years, and 62.5% were men. Patients who died in 2020 were more likely to experience agitation or delirium before death (17.2% vs. 10.9%), to use inotropes/vasopressors near death (59.2% vs. 52.3%), and to receive cardiopulmonary resuscitation in their last months (16.3% vs. 12.5%) than those who died in 2019. Additionally, the number of deaths in the emergency room doubled in 2020 compared to 2019 (from 7.1% to 14.1%).</p><p><strong>Conclusion: </strong>This study suggests that EOL care for cancer patients who died in a tertiary hospital deteriorated during the COVID-19 pandemic. The implementation of medical care at the EOL and the preferred place of death should be discussed carefully in advance for high-quality EOL care.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"150-158"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/38/e2/jhpc-25-4-150.PMC10179996.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183303","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":"Current Status and Future Directions of Research on Palliative Sedation.","authors":"In Cheol Hwang","doi":"10.14475/jhpc.2022.25.4.193","DOIUrl":"10.14475/jhpc.2022.25.4.193","url":null,"abstract":"<p><p>Patients with terminal cancer experience very severe symptoms during the end of life, and palliative sedation (PS) may be considered if those symptoms are refractory to any other treatment. This brief report presents ethical considerations, practices, and recent concerns on PS. PS is quite different from euthanasia. There is a lack of consensus and standards on protocols, but its notable effects have been reported in hospice care settings. Most studies to date have reported no difference in survival between patients receiving PS and those not, and PS must be conducted proportionally with the lightest level of sedation. The most common indication for PS is delirium, and midazolam is the main sedative used. It is recommended that information regarding PS should be provided to patients and their caregivers repeatedly as early as possible. Existential suffering alone is not an indication for PS, and there is a lack of evidence on bispectral analysis. Additional research on PS is needed in Korea.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"193-197"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/50/9a/jhpc-25-4-193.PMC10179994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183298","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}
Thaciane Alves Mota, Manuela Bastos Alves, Ailton de Oliveira Dantas, Erica Brandão de Moraes, Anderson Reis de Sousa, Rudval Souza da Silva
{"title":"Basic Human Needs in the Elderly Receiving Palliative Care: A Scoping Review.","authors":"Thaciane Alves Mota, Manuela Bastos Alves, Ailton de Oliveira Dantas, Erica Brandão de Moraes, Anderson Reis de Sousa, Rudval Souza da Silva","doi":"10.14475/jhpc.2022.25.4.178","DOIUrl":"10.14475/jhpc.2022.25.4.178","url":null,"abstract":"<p><strong>Purpose: </strong>This scoping review identified scientific evidence on basic human needs (BHNs) in the elderly receiving palliative care.</p><p><strong>Methods: </strong>Systematic searches were conducted using six electronic databases (PubMed, CINAHL, Scopus, Lilacs, IBECS, and Web of Science). The initial search resulted in 1,227 articles, of which 104 were identified as potentially relevant. Fifty-three articles that met the inclusion criteria were identified and included in the final analysis.</p><p><strong>Results: </strong>Using the three hierarchical dimensions of the BHN model, 17 needs were organised, with five in the psychobiological dimension, 10 in the psychosocial dimension, and two in the psychospiritual dimension. These needs reflect the importance of care with dignity and relief from suffering for the elderly in palliative care.</p><p><strong>Conclusion: </strong>Recognising impaired BHNs in elderly people receiving palliative care will contribute to better care plans for the elderly, considering the multiple bio-psycho-social-spiritual dimensions of BHNs. This review points to a predominance of psychosocial needs.</p>","PeriodicalId":73780,"journal":{"name":"Journal of hospice and palliative care","volume":"25 4","pages":"178-192"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/92/jhpc-25-4-178.PMC10179993.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10183297","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}