International Journal of Palliative Nursing最新文献

Background: Pain is one of the most frequent symptoms in cancer patients and has a negative impact on their physical, emotional and functional status, as well as their quality of life (QOL). This study evaluated the effectiveness of a pain management programme on pain control and QOL among patients with metastatic cancer receiving systemic chemotherapy. The authors investigated whether a pain management programme contributes to a better pain control and improvement in QOL in the outpatient setting.

Methods: The authors conducted a randomised, single-blinded, controlled, single-centre study of metastatic cancer patients experiencing cancer pain and requiring opioid therapy. Patients were enrolled from the Medical Oncology Outpatient Clinic, Songklanagarind Hospital, Prince of Songkla University, Thailand. Participants were randomly assigned to two strategies: pain assessment and management based on the programme developed by the researchers ('pain management programme' arm), and pain management by individual medical oncologists per the routine procedure ('standard of care' arm). Demographics questionnaires, a pain intensity assessment using the Numeric Rating Scale (NRS) and the Functional Assessment of Cancer Therapy-General (FACT-G, version 4) were used to assess the QOL and cancer pain severity at baseline and at two follow-up visits.

Results: Between November 2016 and July 2017, 64 consecutive patients were randomly assigned to the two treatment groups. Most were male (79.7%), with a mean age of 55.1 (±13.8) years. The majority of patients (23; 35.9%) had squamous cell carcinoma of the head and neck, with other prevalent types being lung cancer (9.4%), esophageal cancer (9.4%) and colorectal cancer (9.4%). The most frequent metastatic sites were the lungs (28.1%), liver (26.6%), and bone (20.3%).

Findings: Compared with standard care, pain intensity was significantly lower among the patients receiving the pain management programme: 4.0 ±2.2 versus 5.1 ±1.8 (P = 0.033) and 3.3 ±1.7 versus 4.7 ±2.1 (P = 0.025) at visit 1 and 2, respectively. Likewise, QOL measures scored higher in the pain management programme group: 71.2 ±15.4 versus 58.6 ±14.5 (P = 0.002) and 71.8 ±15.5 versus 55.4 ±16.3 (P = 0.002) at visit 1 and 2, respectively. Furthermore, there was a statistically significant positive correlation between pain control and QOL improvement (P = 0.011).

Conclusion: The investigated pain management programme significantly improved both pain control and QOL in metastatic cancer patients receiving systemic chemotherapy in the outpatient setting.

Background: In the US, rising rates of opioid abuse has led to regulatory policies designed to curb opioid prescribing. While these policies generally exclude hospice and palliative care from prescribing restrictions, it is not known if these policies have had unintended consequences that affect opioid prescribing within hospice and palliative care.

Methods: A qualitative, descriptive design, guided by the Theory of Planned Behaviour, was utilised to conduct a study to answer the following two research questions: 1) How has the opioid epidemic and related policies affected opioid prescribing practises among hospice and palliative care clinicians? and 2) How do hospice and palliative care clinicians perceive patients' end-of-life care has been impacted by the opioid epidemic and related policies?

Findings: Ten clinicians, comprising physicians and nurse practitioners working in hospice and palliative care settings, were directly interviewed one-on-one. Data analysis revealed that the opioid epidemic and related policies have had an impact on the patient, clinician, nursing and hospice and palliative care speciality.

Conclusions: As the broader medical community shifts away from opioid prescribing, care must be taken to ensure that hospice and palliative care patients still receive access to needed medications. Education is needed to assure that the relief of human suffering at end of life is prioritised.

Background: The use of the standardised nursing language aims to accurately represent clinical practice, contributing to proper documentation and the creation of evidence-based practice.

Aims: To validate nursing interventions (NI) for patients in palliative care, structuring these using the Dignity-Conserving Care Model.

Methods: A methodological study was conducted, developed according to the recommendations of the International Council of Nurses (ICN) and anchored in the Dignity-Conserving Care Model. The NI were developed in four stages: 1) construction of NI, based in the International Standards Organisation's standard (18.104:2014); 2) content validation by 26 expert nurses; 3) cross-mapping with the NIs contained in the International Classification for Nursing Practice (ICNP^®) catalogue, Palliative Care for Dignified Dying, to identify those already existing in the catalogue; and 4) structuring the NI based on the concepts of the Dignity-Conserving Care Model.

Findings: 209 NI were validated and grouped into categories, namely: illness-related concerns; dignity-conservation repertoire; social dignity inventory. Of these, 183 were new and 26 already existed in the ICNP^® Catalogue.

Conclusion: The study presents new insights into palliative care in Brazil and presents 183 new NI in addition to those already published by the ICN.

Background: Choirs are an important source of wellbeing for people experiencing palliative and end-of-life care. Threshold choirs are an innovation that could be more widely introduced, as hospital and palliative care settings have become more open to community input.

Aims: Before such choirs are recommended and encouraged, evidence for their effectiveness and implementation barriers need to be known.

Methods: A literature review was undertaken in 2019 and 2020 using CINAHL, PUBMED, Medline, ProQuest, Google Scholar and an internet manual search.

Findings: The review identified a total of 26 research and discussion papers relevant to the topic of choir in palliative care settings.

Conclusion: Following the review, guidelines were developed that may be useful to assist choirs and service providers to effectively introduce this valuable initiative. Choirs may be a creative, and uplifting arts-based activity to augment and enrich the culture of person-centred care during palliative care processes.

Background: Globally, cancer remains one of the leading causes of mortality. Palliative care is designed to meet a range of cancer patients' priority issues, including the management of pain and other cancer-associated symptoms. Routine palliative care envisages the provision of not just medical therapy, but also psychological support, social support and spiritual assistance. What constitutes the best model for palliative care remains a matter of debate.

Aim: This review was undertaken with the aim to discuss different aspects of early integration of palliative care into oncological care, with a focus on patient-important outcomes.

Methods: A comprehensive search of publications was conducted with a focus on integrative palliative care for incurable cancer patients. For this purpose, the following databases and search engines were used: Scopus, PubMed, Cochrane Library, Research Gate, Google Scholar, eLIBRARY and Cyberleninka.

Results: A comprehensive approach with early integration of different medical services appears to be the most promising. Integrative palliative care is best provided via specialised interdisciplinary teams, given that all members maintain systemic communications and regularly exchange information. This model ensures that timely and adequate interventions are provided to address the needs of patients.

Conclusion: Further research is needed to pinpoint the most optimal strategies to deliver palliative care and make it as tailored to the patient's demands as possible.

Background: In Israel, there is a need to improve quality of life and health outcomes among patients and families facing cancer. Increasing awareness of, literacy about, and availability of palliative care may further this goal.

Aims: This study aimed to adapt a palliative care-focused cancer self- and family management intervention developed in the US for use in Israel.

Methods: The Managing Cancer Care (MCC) psycho-educational intervention is comprised of Managing Cancer Care: A Personal Guide (MCC-PT^©) for patients and Managing Cancer Care: A Caregiver's Guide (MCC-CG^©) for family caregivers. Following translation into Hebrew, an expert panel of Israeli nurses edited the MCC tool for cultural relevance. The authors then conducted qualitative interviews with patients with breast cancer and their family caregivers to obtain feedback. Data were analysed using qualitative content analysis.

Findings: Following recommendations from Israeli experts in oncology and/or palliative care (n=3), the authors revised intervention content specific to the US healthcare system and culture. Patients' (n=13) and family caregivers' (n=10) reported MCC as attractive (70%, 80%), topically relevant (80%, 70%), and culturally appropriate, but felt that palliative care resources should be more Israel-specific.

Conclusion: The MCC tool is acceptable to potential users, warranting further pilot-testing.

Background: Death can cause a great deal of anxiety in nursing students for a variety of reasons. They are expected to provide a high level of care for patients, give the family the respect and patience they deserve and contend with the associated emotional attachments. This raised the question in today's educational world-can the use of technology and simulation aid students in preparing for an end-of-life scenario as part of an undergraduate nursing programme?

Aim: To explore the efficacy of the use of simulations in end-of-life care.

Method: A small study focusing upon the evaluation of an end-of-life simulated scenario for undergraduate second year cross-field Bachelor of Nursing students in a university setting. The simulated scenario consisted of a young patient who was dying and her mother. This project used a mixed approach to address varied students' learning styles and combined the need for visualisation and more structured base-sessions on the topic of death and end-of-life care. One student from the cohort group was randomly assigned as the nurse in charge, while other students were allocated to a scenario (out of a potential four) and provided care in real time. Subsequently, the impact of the scenario was assessed and students were immediately debriefed. Students' response to the scenario was important and needed to be considered, as it directly influenced the debriefing. There were some significant differences between how the students approached the scenario and their reaction to it.

Results: Of the students who took part in the end-of-life simulated scenario, the majority strongly agreed that the simulation increased their clinical reasoning and learning.

Conclusion: The end-of-life scenario was deemed beneficial, despite the emotional impact on the learners involved.