Palliative medicine reports最新文献

Background: Little is known about nursing home (NH) residents' family characteristics despite the important role families play at end-of-life (EOL).

Objective: To describe the size and composition of first-degree families (FDFs) of Utah NH residents who died 1998-2016 (n = 43,405).

Methods: Using the Utah Population Caregiving Database, we linked NH decedents to their FDF (n = 124,419; spouses = 10.8%; children = 55.3%; siblings = 32.3%) and compared sociodemographic and death characteristics of those with and without FDF members (n = 9424).

Results: Compared to NH decedents with FDF (78.3%), those without (21.7%) were more likely to be female (64.7% vs. 57.1%), non-White/Hispanic (11.2% vs. 4.2%), less educated (<9th grade; 41.1% vs. 32.4%), and die in a rural/frontier NH (25.3% vs. 24.0%, all p < 0.001). Despite similar levels of disease burden (Charlson Comorbidity score 3 + 37.7% vs. 38.0%), those without FDF were more likely to die from cancer (14.2% vs. 12.4%), Chronic Obstructive Pulmonary Disease (COPD) (6.0% vs. 4.0%), and dementia (17.1% vs. 16.6%, all p < 0.001), and were less likely to have 2+ hospitalizations at EOL (20.5% vs. 22.4%, p < 0.001).

Conclusions: Among NH decedents, those with and without FDF have different sociodemographic and death characteristics-factors that may impact care at EOL. Understanding the nature of FDF relationship type on NH resident EOL care trajectories and outcomes is an important next step in clarifying the role of families of persons living and dying in NHs.

Background: Idiopathic pulmonary fibrosis (IPF) is a serious illness with an unpredictable disease course and survival rates comparable with some cancers. Patients with IPF suffer considerable symptom burden, declining quality of life, and high health care resource utilization. Patients and caregivers report many unmet needs, including a desire for more education regarding diagnosis and assistance with navigating disease trajectory. Compelling evidence suggests that palliative care (PC) provides an extra layer of support for patients with serious illness.

Research question: The purpose of this survey was to gain perspectives regarding PC for patients with IPF by board-certified pulmonologists in South Carolina (SC).

Study design and methods: A 24-item survey was adapted (with permission) from the Pulmonary Fibrosis Foundation PC Survey instrument. Data were analyzed and results are presented.

Results: Pulmonologists (n = 32, 44%) completed the survey; 97% practice in urbanized settings. The majority agreed that PC and hospice do not provide the same service. There were varying views about comfort in discussing prognosis, disease trajectory, and addressing advance directives. Options for ambulatory and inpatient PC are limited and early PC referral does not occur. None reported initiating a PC referral at time of initial IPF diagnosis.

Interpretation: Pulmonologists in SC who participated in this survey are aware of the principles of PC in providing comprehensive care to patients with IPF and have limited options for PC referral. PC educational materials provided early in the diagnosis can help facilitate and guide end-of-life planning and discussions. Minimal resources exist for patients in underserved communities.

Background: Lebanon is one of the world's smallest countries, with an area of 10,452 square kilometers. Life expectancy in Lebanon presently stands at about 76.6 years for men and 79.3 years for women. It is well known that with long life comes chronic disease, serious illness, and increased resource utilization. With a rapidly aging population and ever-increasing life expectancy, an increase in illnesses that affect the elderly is expected to follow, including non-communicable diseases and cancer. Nurses are the largest workforce in Lebanon and are thus in a prominent position to influence the quality of palliative care (PC) delivery throughout the course of illness.

Purpose: The purpose of this study was to evaluate the impact of an educational workshop on PC knowledge, attitude, and skills for practicing nurses at a Lebanese university medical center.

Design: A mixed-method approach comprising a quasi-experimental and a qualitative process evaluation was followed to assess the nurses' knowledge, attitude, and skills about PC before and after the workshop and to evaluate the process itself. A convenience sample of 45 registered nurses working at the university medical center from multiple clinical units participated in the workshop that took place over one day in a referral medical center in Beirut. Inferential statistical analysis was used.

Results: Data were analyzed using SPSS 25 for Windows. The paired t test showed a significant increase between the pre-and post-test scores t (39) = 11.07, p < 0.001 with a 95% confidence interval for the mean difference of (17.58-25.45). Thirty-eight participants (90.5%) did not pass the pre-test exam whereas only 12 participants (30.0%) did not pass the post-test exam.

Recommendations: It is highly recommended to follow up with the participants of this workshop to determine the immediate and long-term outcomes of this educational workshop as well as offer workshops for a wider population of nurses in Lebanon and the region.

Advances in medicine have made long-term survival of cancer patients possible. Hence, it is now necessary to consider how to approach common symptoms, such as cancer-related pain, in these patients. In this study, we describe a lung cancer patient in whom relief of intractable thoracic pain caused by pleural metastasis was achieved through thoracic radiofrequency thermocoagulation (RF), improving his quality of life (QOL). The patient was a man in his 70s with right upper lobe lung cancer, left 9th -11th rib metastasis, and left thoracic pain associated with parietal pleural metastasis. The patient experienced insomnia and weight loss due to poor appetite caused by opioid analgesics and inadequate pain control. Therefore, RF was performed as interventional treatment, resulting in a decrease in the numerical rating scale score from 10/10 to 2/10, and an improvement in QOL. In cases wherein long-term survival is expected, a long-term treatment plan for chronic cancer-related pain, which has a tendency to become persistent, becomes necessary. RF for the nerve roots might be a viable option for pain caused by pleural metastasis in cancer survivors.

Splanchnic nerve block is considered to be effective for abdominal visceral pain, and is performed for the purpose of controlling abdominal pain and back pain caused by upper abdominal cancer. The patients in this case report were candidates for splanchnic nerve block owing to cancer-associated pain. However, because they could not assume the prone position that is required for the block owing to their pain, combined epidural anesthesia was used, resulting in successful implementation of the splanchnic nerve block. Patients who are candidates for splanchnic nerve block often have advanced cancer, and it is hence often difficult to secure and maintain the position required for the procedure owing to their severe pain. The two patients presented here suggest the possibility that epidural anesthesia might be useful as an adjunct in such cases.

Background: Humor and laughter might have an alleviating effect on pain threshold and enhance coping and building relationships. However, randomized controlled studies in palliative care have struggled with high percentages of attrition and missing values.

Objectives: We aimed to evaluate a study protocol through a pilot study for the evaluation of a multistage humor intervention with psychological and physiological outcome parameters that may be applied successfully in a palliative care environment.

Design: This pilot study utilized a pre-post design. The inclusion of a control group for the final study setting recruiting 120 patients is planned.

Setting/subjects: The study was a monocenter study in a clinic for palliative care in Germany. All patients were eligible for recruitment. Seven patients were recruited for the pilot study.

Measurements: Interventions were developed using a humor training for psychiatric patients. Quantitative sensory testing for pain threshold testing and questionnaires on humor as a character trait, pain intensity, life satisfaction, and symptom burden were planned to be evaluated before and after three humor interventions.

Results: The feasibility of the original study design was re-evaluated after pilot testing. Only two out of the seven patients were able to complete two interventions, requiring modification. Fewer questionnaires, less complex physiological testing, and reduction from three to two interventions were then planned.

Conclusion: The initial planned research methodology must be adjusted for patients with high symptom burden. In the experimental group of the final study setting, the effects of one to two interventions will be evaluated measuring oxytocin levels in saliva and using standardized questionnaires to determine cheerfulness, life satisfaction and symptom burden, as well as assessing as-needed medication.

Trial registration: DRKS00028978 German Registry of Clinical Studies.

Background: Physicians' attitudes can be critical in quality end-of-life care. However, the determinants of the attitudes and whether the attitudes can be modified remain unclear.

Objectives: To investigate factors correlated with physicians' positive attitudes toward end-of-life care and whether these attitudes are modifiable through acquired factors (e.g., education or mentorship).

Design: A nationwide survey was conducted in 300 institutions and selected randomly from 1037 clinical training hospitals in Japan.

Participants: From each selected institution, two resident physicians of postgraduate year (PGY) 1 or 2 and two clinical fellows from PGY 3-5 were requested to answer the survey.

Measurements: The primary outcome was the Frommelt Attitudes Toward the Care of the Dying (FATCOD) scale score. Factors (e.g., the respondents' age, sex, number of years of clinical experience, training environment, religion, and beliefs around death) were examined for correlation with FATCOD score.

Results: In all, 198 physicians and 134 clinical fellows responded to the survey (response rate: 33.0% and 22.3%, respectively). Factors with the strongest correlation with FATCOD scores were mostly unmodifiable factors (e.g., being female and one's beliefs around death). Modifiable factors were also identified-number of patient deaths experienced, level of interest in palliative care, availability of support from senior mentors, and frequency of consultation with nonphysician medical staff.

Conclusion: Physicians' attitudes toward end-of-life care correlate more strongly with nonmodifiable factors, but attitudes can be meaningfully improved via mentoring by senior physicians. Future studies are warranted to determine the effective interventions to foster positive attitudes among physicians involved in end-of-life care.

Context: To assess and address a patient's dignity and dignity-related distress would greatly benefit patients who have advanced stage disease. The Patient Dignity Inventory (PDI) allows clinicians to identify sources of dignity-related distress for patients. The PDI should be evaluated for use in a local Chinese setting.

Objectives: To validate the Patient Dignity Inventory Hong Kong-Chinese (Cantonese) version (PDI-HK) and assess the psychometric properties in patients in an inpatient palliative setting in Hong Kong.

Method: The English version of the PDI was translated and back translated, then reviewed by a panel including a clinician, clinical psychologist, and nurse clinician. Recruited patients would complete the PDI-HK, the Chinese version of Hospital Anxiety and Depression Scale (HADS), the McGill Quality of Life Questionnaire-Hong Kong (MQOL-HK), and the Edmonton Symptom Assessment Scale. Psychometric properties including internal consistency, concurrent validity, test-retest reliability, and factor analysis were tested.

Results: A total of 97 consecutive patients were recruited into the study. The mean PDI score was 51.85 (range 25-102). Cronbach's alpha was 0.953 (p < 0.001). Concurrent validity with the HADS and MQOL-HK questionnaire was established. Factor analysis showed four factors, namely Existential Distress, Physical Change and Function, Psychological Distress, and Support. These were similar to previous PDI validation studies.

Conclusion: The PDI was translated into Chinese (Cantonese) and applied in an inpatient palliative care unit in Hong Kong, with adequate validity. The PDI-HK version can be further used in a larger Chinese population to assess and address dignity-related issues.