Indian Journal of Palliative Care最新文献

In cancer patients, physical and psychological issues are very common. There is a need for family support and high utilisation of healthcare resources commonly. Palliative care (PC) has grown in popularity to better fulfil of needs of patients and their families and potentially lowering hospital costs. Given that the majority of patients still die in hospitals, there is a need for an effective model of PC for advanced gynaecological cancer, as well as the wise allocation of scarce resources. The main aim of this study was to compare the efficacy of PC to conventional treatment for adults with cancer, including gynaecological cancers, and their caregivers. Four randomised controlled trials (RCTs) were identified by searching PubMed, PubMed Central, Clinical Key, Embase and other grey literature from a duration of 2011-2021. Cochrane criteria were used to calculate the risk of bias, and the Grade Profiler Guideline Development Tool was used to check the quality of the included studies. Standardised mean differences (SMDs), I² value and forest plot were prepared by using Review Manager 4.0. A total of four RCTs were extracted by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and found to have a high risk for bias and low to poor quality of evidence. Included study sample sizes ranged from 22 to 104 participants, including 670 people in total, including 289 patients with advanced cancer patients, including gynaecological cancer and 381 unpaid caregivers. Results also showed that PC enhances patients' quality of life (SMD = 0.26; 95% confidence interval [CI] = -0.29-0.80; I² = 76%), lowered symptom burden amongst patients (SMD = -0.75, 95% CI = -1.75-0.25; I² = 89%), reduces patient depression (SMD = 0.08, 95% CI = -0.19-0.34; I2 = 0%) and decreases depression in unpaid caregivers (SMD = -0.16, 95% CI = -0.56-0.24; I² = 59%). PC treatment increases patients' quality of life and lowers their symptom burden. In comparison to conventional care, it also reduces depression among patients and caregivers. We believe that the findings should be viewed with care until more recent exclusive RCTs are available.

Spiritual intelligence (SI) has recently gained traction in various fields, including nursing. Given the increasing emphasis on patient-centred care and the holistic well-being of patients and nurses, SI is particularly relevant in nursing practice. A bibliometric analysis of recent publications (2014-2024) in the field helps synthesise and evaluate the existing research on SI in the general field of nursing, identify literature gaps, suggest future research directions and raise awareness of the importance of SI in nursing practice. The present study reports bibliometric data (n = 461) from the Scopus database on SI, spiritual quotient and spiritual care in nursing and health care. The data are analysed using MS Excel and VOSviewer software. The publications' trend analysis revealed a significant increase in SI-related publications since 2015. The study presents top-cited articles. Journal of Religion and Health was found to be a prominent journal with the maximum number of publications, and Sage was found to be the top publisher of journals with articles on SI. Network visualisation reveals central figures such as Wilfred McSherry, Trove Giske, Elizabeth Johnston Taylor, Fiona Timmins, Silvia Caldeira and Linda Ross as key researchers in the field. The United States and Iran have the most substantial connections of authors publishing on SI. This study reveals an increasing interest in SI and care within nursing research, confirming its growing significance in the field. By reporting areas where research on SI in nursing remains underdeveloped, the study paves the way for the development of new or updated curricula in nursing programs. The study can guide faculty development initiatives by highlighting the importance of SI and providing resources for educators to incorporate these concepts into their teaching. This study presents specific research questions to address these knowledge gaps. Future studies which can address these questions will enrich nursing education and practice, leading to improved patient outcomes and enhanced nurse well-being using the full potential of SI in nursing practice.

Objectives: The objectives of the study are to assess changes in the quality of life amongst breast cancer patients undergoing treatment at a cancer institute in Colombia.

Materials and methods: Analytical observational prospective cohort study in patients over 18 years of age diagnosed with breast cancer. Health-related quality of life (HRQoL) was analysed using the EQ-5D-3L questionnaire and a Visual Analogue Scale measured at diagnosis and after a 6-month follow-up. Sociodemographic and clinical factors were analysed using a logistic regression model, with STATA 16 software.

Results: A total of 103 patients met the included criteria and were included in the study, with a median age of 56 years. According to the Tumour, Node, Metastasis classification of cancer stage, the majority of participants (35.92%) were in stage 2 of cancer. Multivariate analysis revealed that changes in HRQoL were significantly associated with age (odds ratio [OR] = 1.06, P = 0.001), radiotherapy (OR = 3.56, P = 0.038) and moderate anxiety and depression (OR = 5.54, P = 0.007).

Conclusion: While the overall quality of life in women with breast cancer showed a slight improvement over the 6 months, older patients and those receiving radiotherapy experienced a greater decline in health perception.

Objectives: This study was conducted to determine and correlate the perception of social support and the prevalence of self-reported depressive symptoms among patients with head-and-neck squamous cell carcinoma (HNSCC).

Materials and methods: This cross-sectional study included 100 patients with HNSCC receiving treatment at a tertiary cancer centre in north India. They were enrolled by a convenient sampling technique. Subsequently, data regarding sociodemographic profile, clinical profile, perception of social support and prevalence of self-reported depressive symptoms were collected through face-to-face interviews using a subject datasheet, Multidimensional Scale of Perceived Social Support (MSPSS) and Patient Health Questionnaire-9.

Results: Most of the HNSCC patients, 37%, were in the 42-54 years age category. A male gender predilection (85%) was noted. The two most common subsites involved were the oral cavity (61%) followed by the oropharynx (26%). A majority, 60% of the patients had high social support. Among the subscales of the MSPSS, high social support was obtained majorly from the family (98%), followed by significant others (66%) and friends (52%). The prevalence of self-reported moderate-to-severe depressive symptoms was noted in 36% of patients. The perception of social support and the prevalence of self-reported depressive symptoms showed a weak negative correlation (r = -0.262, P = 0.008).

Conclusion: Despite receiving high social support, there was a high prevalence of self-reported moderate-to-severe depressive symptoms in patients with HNSCC. Therefore, it is pertinent to monitor the mental health of patients afflicted with HNSCC and provide mental health rehabilitation as per their needs.

The older population is susceptible to dementia, Alzheimer's and depression. A growing elderly population poses a burden on caregivers and society. If their cognitive and psychological health is maintained, they may not need to depend on others for their needs, thereby reducing the burden on caregivers. This, in turn, may lead to a decrease in the necessity for consulting healthcare providers for psychological health, subsequently reducing the overall cost of healthcare. There are numerous options for improving cognitive and mental health in the elderly, one of which is music therapy (MT). In this systematic review, we aim to demonstrate the efficacy of MT in enhancing psychological health among the geriatric population afflicted with dementia and depression. A systematic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Scopus, ScienceDirect, and Cochrane databases. The inclusion criteria were randomized controlled trials (RCTs) that explored the use of MT in elderly patients with or without depression, dementia, or Alzheimer's. Non-RCTs, retrospective and prospective observational studies, case reports, and case series were excluded. Out of 76 records identified, eight articles were selected for qualitative synthesis and three for meta-analysis. These studies, conducted between 2010 and 2020, involved a total of 605 subjects, with 330 receiving MT and the remainder serving as controls. The interventions varied in terms of music type, duration, and setting, with outcome measures including depression scales, quality of life assessments, and cognitive examinations. The meta-analysis of depression scores indicated a positive effect of MT, though a wide confidence interval warrants caution. The quality assessment revealed varying risks of bias, highlighting the need for further research to confirm the positive role of MT. In conclusion, MT emerges as a promising intervention, but it is accompanied by considerable limitations and heterogeneity among studies. This emphasizes the need for further RCTs that specifically address the identified limitations, including issues related to sample size, control group selection, and potential confounding factors. Conducting more robust research in these areas is crucial to establishing a clearer understanding of the therapeutic benefits of music in the elderly population.

Objectives: The objective of this study was to achieve integration of goals of care discussion (GOCD) as a routine part of assessment among seriously ill patients admitted to medical wards and assess its impact on patient satisfaction, caregiver satisfaction and quality of life (QOL).

Materials and methods: This was non-randomised before and after study - A quality improvement project involving three plan-do-study-act (PDSA) cycles each of 6 weeks duration. The study included a total of 60 patients and their caregivers admitted to the Internal Medicine Unit in a tertiary care hospital in South India. Junior residents from Internal Medicine were trained in conducting a GOCD through a face to face training session and through an online training program using capc.org modules. Through a process of three PDSA cycles, we introduced the documentation of GOCD as a routine part of the assessment of seriously ill patients and assessed its impact on QOL and patient satisfaction.

Results: Following the introduction of GOCD, patient and caregiver satisfaction had a statistically significant improvement across the majority of the assessed domains, and there was an overall improvement in the mean World Health Organization QOL Brief Version QOL scores by 4.8.

Conclusion: Among patients with serious illness, GOCD improved patient and caregiver satisfaction and QOL. Such conversations are essential to align the care delivery with patient preferences and help in providing patient-centred care.

Objectives: Mortality is a common gauged endpoint in critically ill patients. Reduced quality of life is an aligned repercussion of protracted critical illness. Baseline status, severity of illness and its trajectory influence the outcomes. Patient-oriented outcomes are those that matter the most to a patient. However, quite often, family approves of trade-offs with survivorship in the Indian context. We looked at non-mortality outcomes in patients on high-intensity life-sustaining interventions admitted to the intensive care unit (ICU) despite poor prognosis and died on full support or survived to be completely dependent.

Materials and methods: In this retrospective chart review study, we studied patients (1) who spent more than 1 month in the hospital enduring a myriad of distressing physical and psychological vicissitudes, (2) whose primary illness was fairly advanced (3) and either succumbed or survived to be impeded in their response to cognitive assessment and with severe functional impairment. Patient demographics, comorbidities, pre-morbid functional status, burden of critical illness, use of life-sustaining therapies, functional dependence in the last week of ICU stay, best neurological status in the last week pre-death or discharge, dying trajectories and economic analysis were noted.

Results: Trends of clinical progress of 23 patients were deliberated. The mean age of males was 65 years and 61 years for females. Five patients had a Barthel index score of 10-20, indicating total dependency and two patients had a score of 21-60, indicating severe dependency. Two patients were cognitively impaired at baseline. The worst neurological status in the week before death or discharge was eye1, motor1, and verbaltracheostomised. Thirteen patients succumbed during ongoing treatment.

Conclusion: Daily discussions on the dynamics of illness progression need to take place with family on a regular basis for patients managed in ICU. Realistic perceptions and grounded expectations from the families and caregivers are necessary for patient-centred outcomes.

Objectives: In this study, our primary objectives were to validate the palliative prognostic index (PPI) tool in the context of palliative care for patients with advanced cancer. Specifically, we aimed to assess the accuracy of the PPI in predicting actual survival in these patients through prospective validation.

Materials and methods: To achieve our objectives, we enrolled a cohort of 227 advanced cancer patients receiving palliative care. The study population comprised 132 (58.1%) men and 95 (41.9%) women, with a median age of 52 years (Range: 20-81). Among them, 56 (24.7%) underwent chemotherapy, and 26 (11.5%) underwent palliative radiotherapy. We utilised the PPI score to categorise patients into three prognostic groups: (a) PPI score <4 indicating likely survival of more than 6 weeks; (b) PPI score 4-6 indicating likely survival shorter than 6 weeks; and (c) PPI score >6 indicating likely survival <3 weeks.

Results: Through our analysis, we found that the PPI demonstrated limited predictive capabilities, particularly for short-term survival (<3 weeks). The PPI's performance metrics included a positive predictive value of 45.24%, a negative predictive value of 100%, a sensitivity of 100.00% and a specificity of 88.94%.

Conclusion: In conclusion, our study establishes the limited reliability of the PPI in predicting short-term survival (<3 weeks) among patients in palliative care with advanced cancer. These findings underscore the PPI's potential as a valuable tool for healthcare professionals, aiding in the development of treatment plans and facilitating discussions on end-of-life care options with patients and their families. In addition, the PPI may assist healthcare professionals in identifying individuals who could benefit from more aggressive interventions or those approaching the end of life, thereby guiding the provision of additional support and care.

The paper is based on mixed-methods analysis, including qualitative (thematic analysis) and quantitative (word frequency and trends analysis), to thoroughly investigate the existing body of literature pertaining to the influence of social media (SM) on palliative care (PC). The time frame of the analysis is for a 5-year (2018-2023). The paper attempts to explore dominating themes and explore how SM has impacted the arena of palliative, how these platforms affect patient and community involvement and how successful digital communication tactics are when used to advocate for PC.