Indian Journal of Palliative Care最新文献

Pregabalin is an essential pharmacological aid in pain and palliative care practice. Its use has significantly improved pain control, both for acute and chronic conditions, when helping to reduce the need for opioids. Despite these benefits, the misuse of pregabalin has become a serious issue. The reasons cited by patients for pregabalin use included reduced opioid cravings, sedation, euphoria, relief from opioid withdrawal symptoms and anxiety relief. Stringent steps should be taken to address the misuse of pregabalin while ensuring that it remains a useful therapeutic tool. To ensure that pregabalin remains effective for patients without exacerbating the substance misuse problem, it is important to enhance regulations, boost patient education and establish thorough prescribing and monitoring practices.

Objectives: Cancer patients endure a significant burden, both physically and psychologically. This burden encompasses the symptoms of the disease itself, treatment toxicity, alterations in body image, diminished performance status, pain, lack of a supportive environment and existential distress. These factors contribute to a reduced quality of life and may ultimately erode the patient's dignity. This study aims to assess the overall quality of life and dignity experienced by patients with cancer, utilising established inventories in the Greek context. In addition, the study seeks to investigate the potential impact of quality of life on patients' sense of dignity.

Materials and methods: The study sample comprises 100 cancer patients undergoing definitive or palliative radiotherapy, with Eastern Cooperative Oncology Group (ECOG) performance status ranging from 0 to 3. Among the participants, 46% were male and 54% were female, with a median age of 63 years (range: 32-87 years). Assessment tools included the Greek versions of three inventories: The MD Anderson symptom inventory, the patient dignity inventory and the Functional Assessment of Chronic Illness Therapy (FACIT)-Palliative, version 4.

Results: Demographic analysis revealed that ECOG performance status emerged as the sole characteristic significantly impacting patients' dignity. Regarding quality of life, factors such as FACIT-emotional well-being, FACIT-physical well-being and additional concerns demonstrated a discernible influence on patients' sense of dignity.

Conclusion: This study underscores the significance of dignity preservation as a pertinent concern among cancer patients. Furthermore, it identifies quality of life-related factors as prognostic indicators for the erosion of patient dignity.

Objectives: Breast cancer is a life-altering diagnosis that can significantly impact the mental health of patients. Understanding the trajectories of psychological symptoms is crucial for providing effective support and interventions. This empirical research paper aims to investigate the longitudinal trajectories of depression, anxiety, and stress among breast cancer patients within the first year of diagnosis.

Materials and methods: A longitudinal study design was employed to assess depression, anxiety, and stress levels at four-time points: baseline (diagnosis), 3 months, 6 months, and 12 months after diagnosis. The participants included breast cancer patients (n = 200) recruited fro m the outpatient as well as inpatient department of Surgical Oncology, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India. The Depression, Anxiety, and Stress Scale-21 was administered to measure psychological symptoms. Trajectories of depression, anxiety, and stress were analysed using mixed-effects modelling.

Results: The results indicated varying trajectories of depression, anxiety, and stress during the 1^st year of diagnosis. At baseline, participants reported significantly higher levels of depression (Mean [M] = 16.42, standard deviation [SD] = 4.89), anxiety (M = 14.36, SD = 5.22), and stress (M = 18.58, SD = 5.72) compared to the general population norms. Over the 12 months, depression levels gradually decreased (β = -0.28, P < 0.001), anxiety levels remained relatively stable (β = -0.15, P < 0.05), while stress levels showed a significant decrease (β = -0.14, P < 0.05).

Conclusion: The findings suggest that breast cancer patients experience distinct trajectories of psychological symptoms during the 1^st year of diagnosis. While depression showed a gradual decline, anxiety remained relatively stable, and stress exhibited a significant decrease. These results indicate the importance of addressing psychological well-being throughout the cancer journey, as patients may face different emotional challenges at various stages.

Objectives: Patient Health Questionnaire 9 (PHQ-9) has previously undergone validation with patients with various types of cancer, but psychometric validation of PHQ-9 Hindi among patients with cancer receiving palliative care services in northern regions of India is required. This study aimed at psychometric validation of a culturally adapted version of PHQ-9 Hindi for early screening of depression among cancer patients receiving palliative care services in a community setting.

Materials and methods: A sample of adult patients (n = 228) with cancer receiving palliative care services in a community setting participated in the research. A 50% subset of the sample was contacted for repeat assessment twice, each after a period of 3-4 weeks. For validation, a previously adapted version of PHQ-9 Hindi, along with a demographic sheet, was employed to collect data. In addition, we used the recently validated Integrated Palliative Care Outcome Scale to assess the validity of PHQ-9 within palliative care settings. Exploratory and confirmatory factor analyses were conducted, followed by test-retest reliability, interclass correlation, construct validity and divergent validity examination.

Results: The exploratory factor analysis revealed a two-factor solution consistent with the hypothesised model, yielding two sub-scales namely, physical and emotional concerns. The confirmatory factor indices within our sample were conclusive suggesting a relatively good fit between the hypothesised model and the observed data, thus confirming the cross-cultural validity of PHQ-9 Hindi. The physical sub-scale confirmed moderate internal consistency (α = 0.5) while the emotional sub-scale presented high internal consistency (α = 0.734). The associations between PHQ-9 Hindi with IPOS Hindi individual items were significant (P < 0.001).

Conclusion: A psychometrically validated version of PHQ-9 Hindi has been presented to screen depression among patients with cancer in northern parts of India. Further research is required to adapt and check the validity of PHQ-9 in other regional languages among different populations across the country.

Objectives: The aim of this study was to evaluate the impact of 'Cognitive Training' on cognitive functions, self-care, medication adherence, QOL, functional capacity and satisfaction level among HF patients.

Materials and methods: In the current randomised controlled trial, 60 HF patients were enrolled from the cardiology outpatient department by total enumeration sampling technique and randomised into the 30 control and 30 experimental group participants using a random number table. A socio-demographic cum clinical profile sheet, Montreal cognitive assessment, self-care of HF index, Hill-Bone medication adherence scale, Minnesota living with HF questionnaire (MLHFQ), 6-min walk test and satisfaction questionnaire were used for collecting data and pre-test was done at the time of enrolment. The experimental group participants received cognitive training through face-to-face counselling sessions provided by the researcher along with routine care. Control group participants received routine care. Post-test was done at the end of the 12^th week to assess the impact of Cognitive training on cognitive functions and other variables. Descriptive and inferential statistics were used to analyse the data.

Results: Significant improvement was observed in cognitive functions which include memory (P < 0.001), executive functions (P < 0.001) and attention and concentration (P < 0.001) among the experimental group participants in the 12^th week. Furthermore, significant improvement was observed in self-care maintenance (P < 0.001), self-care management (0.04), self-care confidence (P < 0.001), medication adherence (P < 0.001), QOL (P < 0.001), functional capacity (0.002) as well as satisfaction with care provided.

Conclusion: Cognitive training was found to be effective in terms of improvement in cognitive functions and it should be part of the routine intervention in healthcare settings for better patient outcomes.

Objectives: Anaemia is prevalent in individuals with advanced cancer and may contribute to adversely affecting their quality of life. In palliative care (PC), red blood cell (RBC) transfusions are regularly administered to address bothersome symptoms such as fatigue and dyspnoea. However, they are not without risks and adverse effects in individuals who are often frail at the end of life. Within this context, RBC transfusion benefits and drawbacks have yet to be demonstrated. This study aimed to assess RBCs transfusion-targeted indications, practices and clinical outcomes at the end-of-life in hospitalised patients with advanced malignancy.

Materials and methods: A retrospective cohort design was used. All adults with a cancer diagnosis admitted to a PC Unit in a tertiary care centre in Saudi Arabia and who received at least one RBC transfusion between 1 January 2020 and 1 January 2024 were included in the study. Data were retrieved from their medical records (demographics, clinical and transfusion episode information) and included the Charlson Comorbidity Index.

Results: A total of 84 patients were included, comprising a total of 159 episodes of transfusion. Patients had a mean age of 47 years (19.4%). The most frequent location of cancer was the gastrointestinal system (34.6%). For most patients, a low haemoglobin level was the main indication for the transfusion, without precise symptoms being targeted. There was no improvement following several transfusion episodes (82.4%). A moderate negative correlation was observed between age and survival days post-transfusion.

Conclusion: There is a need for further studies to better understand the benefits of RBC transfusions at the end of life. In addition, more attention is warranted to establish targeted clinical outcomes pre-transfusion rather than relying on abnormal laboratory values. Validated self-reported tools should be used to ensure the benefits of an intervention that involves such a limited and valuable resource.

Objectives: The purpose of this study is to compare the treatment given to cancer patients in intensive care units (ICUs) who require or do not require hospice care.

Materials and methods: A descriptive retrospective design was used. A total of 193 files were reviewed for admitted cancer patients.

Results: Individuals requiring hospice care had longer hospital stays (t=1.22, p<.05) and were less likely to be sent to palliative care (X2= 183.5, p<.05). The majority of patients were intubated (72.4%), got intravenous hydration (84.5%), and received antibiotics (81.3%). There was a statistically significant difference in the fluid administration (X2= 1.76, p<.05), antibiotic administration (X2= 1.64, p<.05), and mechanical ventilation (X2= 2.71, p<.05) between individuals who require hospice care and those who do not.

Conclusion: It is necessary to enhance the dialogue between doctors, patients, and caregivers regarding peaceful death and reduce unnecessary treatment.

Objectives: Music therapy can be a harmonising hope for cancer patients under palliative care to overcome fear, anxiety, anger, depression, pain and the range of emotional responses. Music therapists contribute to a comprehensive approach to providing holistic, patient-centred care to mainstream medical treatment. Hence, the study aims to understand the clinical impact of music therapy in cancer pain and palliative care.

Materials and methods: After approval from the Institutional Review Committee and getting informed consent, a total of 102 individual music therapy sessions were conducted for 43 patients with cancer hospitalised under palliative care. Each patient received an average of 2-4 music therapy sessions by a certified music therapist. Music therapy sessions were based on clinician referrals, hospitalisation status and musicality profile. Pain scores, anxiety scores, mood scores and intrinsic and extrinsic motivation levels were evaluated using a visual analogue scale before and immediately after the sessions. Data were statistically analysed using the Statistical Package for the Social Sciences version 26.

Results: The study indicates that cancer patients undergoing pain and palliative care experienced notable outcomes from music therapy sessions, including a significant decrease in anxiety and pain perception, along with enhancements in mood and motivation (P < 0.01).

Conclusion: To sum up, the ongoing study and understanding of the impact of music therapy underscore its meaningful and promising role in improving the overall quality of life for cancer patients within a holistic care approach.

Objectives: Caring for ill cancer patients imposes a considerable burden on families, significantly reducing quality of life (QoL). This study examined the association between death preparation and QoL amongst family caregivers (FCs) of terminally ill patients with cancer in South Korea.

Materials and methods: A multicentre cross-sectional survey using questionnaires was conducted in nine inpatient palliative care units in South Korea. Data from 170 FCs who answered questions about preparedness for death were analysed. A stepwise multivariate logistic model was used to identify the factors associated with FCs' QoL. The estimated QoL scores were also compared between the groups according to preparedness level.

Results: Factors associated with high QoL included old age, fewer daily caregiving hours, fewer caregiving durations and practical preparedness for death. The well-prepared group had significantly higher QoL scores in the burdensome domain. This significant association remained robust in FCs with low educational or social support levels, poor resilience and dysfunctional families.

Conclusion: Practically, well-prepared FCs experienced a high QoL in hospice care settings. FCs are likely to benefit from assessment and encouragement of their preparedness for death.

Objectives: This study explores the lived experiences of elderly transgender individuals residing in trans communities in Pondicherry, with a focus on their challenges in accessing end-of-life care and the broader societal, economic, and intergenerational issues affecting their well-being.

Materials and methods: A phenomenological approach with descriptive analysis was employed over eight months. Six transgender individuals aged 50 and above were selected through purposive sampling. Baseline data were collected using a structured questionnaire, followed by in-depth, semi-structured interviews conducted via Zoom. Each interview, lasting approximately one hour, was recorded, transcribed verbatim, and analysed using Hermeneutic Phenomenology to identify key themes.

Results: Eight constitutive themes emerged from the analysis: Challenges in Self-expression, reflecting struggles in living authentically; Dependency, indicating reliance on others for support; Generation Gap with Community Members, revealing disparities in values and perspectives; Handling Daily Struggles, highlighting daily adversities; Unheard Complaints, emphasizing societal neglect; Feeling Useless and a Burden, indicating diminished self-worth; Shrinking to Self, showing social withdrawal; and Segregation or Solitary Living, illustrating experiences of exclusion and isolation. These themes are encapsulated in the overarching theme, "Navigating Isolation and Dependency in the Lived Experience of Elderly Transgender Individuals."

Conclusion: The study reveals the profound impact of societal discrimination, economic hardship, and intergenerational gaps on elderly transgender individuals. It underscores the urgent need for advocacy, inclusive policies, and community-based support systems to address their unique challenges and enhance their quality of life, particularly in end-of-life care contexts.