Pub Date : 2016-09-30DOI: 10.4172/2165-7386.1000E139
H. Charalambous, M. Silbermann
We have witnessed great progress in both Oncology (Onc) and Palliative Care (PC) in the last twenty years. In Onc we have witnessed the establishment of Multi-Disciplinary Teams and meetings, centralization of care, new Radiotherapy (RT) techniques: Intensity Modulated RT, Image Guided RT and stereotactic RT, to the revolution of molecular biology, with the understanding of oncogenic addiction, the emergence of targeted therapy and now immunotherapy with checkpoint inhibitors. In PC, essentially a new specialty was set up in many countries worldwide with major steps made in capacity building leading up to integration in a few countries [1,2]. Furthermore, there has been a recognition of the important role of PC in the palliation of patients with advanced illness, whilst more recently evidence for the earlier integration of PC in the disease trajectory has been produced [3,4].
{"title":"The Role of the Cancer Center in Supporting Palliative Care Services Development","authors":"H. Charalambous, M. Silbermann","doi":"10.4172/2165-7386.1000E139","DOIUrl":"https://doi.org/10.4172/2165-7386.1000E139","url":null,"abstract":"We have witnessed great progress in both Oncology (Onc) and Palliative Care (PC) in the last twenty years. In Onc we have witnessed the establishment of Multi-Disciplinary Teams and meetings, centralization of care, new Radiotherapy (RT) techniques: Intensity Modulated RT, Image Guided RT and stereotactic RT, to the revolution of molecular biology, with the understanding of oncogenic addiction, the emergence of targeted therapy and now immunotherapy with checkpoint inhibitors. In PC, essentially a new specialty was set up in many countries worldwide with major steps made in capacity building leading up to integration in a few countries [1,2]. Furthermore, there has been a recognition of the important role of PC in the palliation of patients with advanced illness, whilst more recently evidence for the earlier integration of PC in the disease trajectory has been produced [3,4].","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000E139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70686244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-29DOI: 10.4172/2165-7386.1000285
I. Benkel, U. Molander
Objective: Although having difficult conversations is part of their role, many professionals feel that they are often ill-equipped to deal with them. Professionals need training in how best to meet difficult questions so that the conversation can flow effectively. This study is a continuation of an earlier study on how healthcare professionals described strategies to facilitate difficult conversations. Methods: A qualitative method with in-depth interviews was chosen to acquire a deeper understanding of the participants' strategies in having these conversations. In order to strengthen the knowledge of and strategies for conducting their difficult conversations in particular, we examined the interviews with the physicians who participated in the study. Results: The study describes a conversation pattern to help in dealing with difficult conversations. This conversation pattern can help physicians to have conversations that flow effectively and that move in a straightforward way. The different strategic areas described in this study were: Introduction; Finding out what the patient and loved ones already know; Discuss the actual problem; Find out how the patient feels and what is most urgent for the patient to deal with; Planning for the future; and Summary. There are important factors that need to be considered in having these conversations which, in addition to the medical knowledge, include the strategies adopted by patients and families, hope, and how the family constellation might influence the conversation. Conclusion: This framework for difficult conversations can be helpful for physicians to improve conversations with the patient and her/his family in their life situation where a fatal disease has influenced their life within many dimensions. Developing their conversational skills and strategies in combination with a carefully planned structure appeared to facilitate difficult conversations with patients, families and loved ones.
{"title":"How do Physicians Talk and what do They Say in the Difficult Conversationswith Patients and their Loved Ones in Palliative Care? A Qualitative Study to Investigate Strategies to Help Improve Difficult Conversations","authors":"I. Benkel, U. Molander","doi":"10.4172/2165-7386.1000285","DOIUrl":"https://doi.org/10.4172/2165-7386.1000285","url":null,"abstract":"Objective: Although having difficult conversations is part of their role, many professionals feel that they are often ill-equipped to deal with them. Professionals need training in how best to meet difficult questions so that the conversation can flow effectively. This study is a continuation of an earlier study on how healthcare professionals described strategies to facilitate difficult conversations. Methods: A qualitative method with in-depth interviews was chosen to acquire a deeper understanding of the participants' strategies in having these conversations. In order to strengthen the knowledge of and strategies for conducting their difficult conversations in particular, we examined the interviews with the physicians who participated in the study. Results: The study describes a conversation pattern to help in dealing with difficult conversations. This conversation pattern can help physicians to have conversations that flow effectively and that move in a straightforward way. The different strategic areas described in this study were: Introduction; Finding out what the patient and loved ones already know; Discuss the actual problem; Find out how the patient feels and what is most urgent for the patient to deal with; Planning for the future; and Summary. There are important factors that need to be considered in having these conversations which, in addition to the medical knowledge, include the strategies adopted by patients and families, hope, and how the family constellation might influence the conversation. Conclusion: This framework for difficult conversations can be helpful for physicians to improve conversations with the patient and her/his family in their life situation where a fatal disease has influenced their life within many dimensions. Developing their conversational skills and strategies in combination with a carefully planned structure appeared to facilitate difficult conversations with patients, families and loved ones.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000285","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-23DOI: 10.4172/2165-7386.1000286
G. Eduardo, B. Primo, L. Ferreira, A. C. Carvalho
Grossmann Eduardo1*, Bruno Primo2, Luciano Ambrosio Ferreira3 and Antônio Carlos Pires Carvalho4 1Craniofacial Pain Applied to Dentistry Discipline, Federal University of Rio Grande do Sul and Pain and Orofacial Deformity Center, CENDDOR, Porto Alegre, Brazil 2Department of Oral and Maxillofacial Surgery, School of Dentistry, ULBRA, Canoas, RS, Brazil 3Maternity Hospital Therezinha Jesus-HMTJ/JF and Supreme-Faculty Medical and Health Sciences. Juiz de Fora, MG, Brazil 4Department of Radiology, Postgraduate Program in Medicine, Federal University of Rio de Janeiro
Grossmann Eduardo1*， Bruno Primo2, Luciano Ambrosio Ferreira3和Antônio Carlos Pires Carvalho4 1颅面疼痛在牙科学科中的应用，巴西阿雷格里港，巴西格兰德州联邦大学疼痛和口腔面部畸形中心，巴西，阿雷格里港2口腔颌面外科，ULBRA, Canoas, RS，巴西，牙科学院3 therzinha Jesus-HMTJ/JF妇产医院和最高医学与健康科学学院。Juiz de Fora, MG，巴西4里约热内卢联邦大学放射学系，医学研究生课程
{"title":"A Rare Case of Surgical Treatment of Projectile in the Infratemporal Fossa","authors":"G. Eduardo, B. Primo, L. Ferreira, A. C. Carvalho","doi":"10.4172/2165-7386.1000286","DOIUrl":"https://doi.org/10.4172/2165-7386.1000286","url":null,"abstract":"Grossmann Eduardo1*, Bruno Primo2, Luciano Ambrosio Ferreira3 and Antônio Carlos Pires Carvalho4 1Craniofacial Pain Applied to Dentistry Discipline, Federal University of Rio Grande do Sul and Pain and Orofacial Deformity Center, CENDDOR, Porto Alegre, Brazil 2Department of Oral and Maxillofacial Surgery, School of Dentistry, ULBRA, Canoas, RS, Brazil 3Maternity Hospital Therezinha Jesus-HMTJ/JF and Supreme-Faculty Medical and Health Sciences. Juiz de Fora, MG, Brazil 4Department of Radiology, Postgraduate Program in Medicine, Federal University of Rio de Janeiro","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2016-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000286","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-23DOI: 10.4172/2165-7386.1000284
J. Barling, K. Davis
Research of AYAs with cancer has developed significantly over the last 20 years. The research has demonstrated that AYAs with cancer are a forgotten population, who require closer study in order to understand their unique issues. This paper examines family members’ experiences of adolescents and young adults (AYAs) during the dying stage of their cancer trajectory. The results are drawn from a larger study titled ‘From Go to Woe; Family Members’ Stories of Adolescents and Young People Living with and Dying from Cancer, which storied the family members’ experience of the diagnosis, treatment, dying and death of an AYA family member, utilizing Armstrong-Coster’s (2004) four stages of the cancer trajectory. The principal researcher’s motivation to understand and story these experiences was related to her own isolation and lack of information when her 16 year old son Anthony, was diagnosed with and eventually died of cancer at 17 years of age. The significance of this study is the contribution made to the identification of issues that can inform health policy/ guidelines. The findings have the potential to increase understanding of, and prepare family members and AYAs with cancer, for the experience of the death and dying stage of the cancer trajectory.
在过去的20年里，对AYAs与癌症的研究取得了显著进展。研究表明，患有癌症的aya是一个被遗忘的人群，为了了解他们的独特问题，需要对他们进行更深入的研究。本文探讨了青少年和青壮年(AYAs)在其癌症轨迹的临终阶段的家庭成员的经历。这些结果来自于一项更大的研究，名为“从去到祸;Family Members ' Stories of Adolescents and Young People with Cancer and Dying with Cancer，它利用Armstrong-Coster(2004)的癌症发展轨迹的四个阶段，讲述了家庭成员对AYA家庭成员的诊断、治疗、死亡和死亡的经历。首席研究员理解和讲述这些经历的动机与她自己的孤立和缺乏信息有关，当她16岁的儿子安东尼被诊断出患有癌症并最终在17岁时死于癌症。这项研究的意义在于，它有助于确定可以为卫生政策/指导方针提供信息的问题。这些发现有可能增加对癌症的理解，并为癌症轨迹的死亡和临终阶段的经历做好准备。
{"title":"Stories of Dying and Death as told by Family Membersâ of Adolescents andYoung Adults (AYAs) who have Died from Cancer","authors":"J. Barling, K. Davis","doi":"10.4172/2165-7386.1000284","DOIUrl":"https://doi.org/10.4172/2165-7386.1000284","url":null,"abstract":"Research of AYAs with cancer has developed significantly over the last 20 years. The research has demonstrated that AYAs with cancer are a forgotten population, who require closer study in order to understand their unique issues. This paper examines family members’ experiences of adolescents and young adults (AYAs) during the dying stage of their cancer trajectory. The results are drawn from a larger study titled ‘From Go to Woe; Family Members’ Stories of Adolescents and Young People Living with and Dying from Cancer, which storied the family members’ experience of the diagnosis, treatment, dying and death of an AYA family member, utilizing Armstrong-Coster’s (2004) four stages of the cancer trajectory. The principal researcher’s motivation to understand and story these experiences was related to her own isolation and lack of information when her 16 year old son Anthony, was diagnosed with and eventually died of cancer at 17 years of age. The significance of this study is the contribution made to the identification of issues that can inform health policy/ guidelines. The findings have the potential to increase understanding of, and prepare family members and AYAs with cancer, for the experience of the death and dying stage of the cancer trajectory.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2016-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-17DOI: 10.4172/2165-7386.1000283
Francisca Rego, R. Nunes
{"title":"The Spiritual Advocate in Palliative Care","authors":"Francisca Rego, R. Nunes","doi":"10.4172/2165-7386.1000283","DOIUrl":"https://doi.org/10.4172/2165-7386.1000283","url":null,"abstract":"","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2016-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-16DOI: 10.4172/2165-7386.1000282
Chih-Chuan Hsieh, Chiao-Zhu Li, Mengchi Li, Yun-Ju Yang, Kun-Ting Hong, Chi-tun Tang, T. Chung, D. Ju, C. Yeh, Yuan-Hao Chen, Dueng-Yuan Hueng
Background: Withdrawal of life-sustaining treatment (WLST) is an option in end-of-life of critical illness in a surgical/neurosurgical intensive care unit (SNICU). In addition to lessen the patient’s suffering and to comfort the surrogates’ grief, there is something meaningful, such as tissue donation, for others to pursue. Aim: The aim of this study is to investigate the relationship between surgical intervention and the willingness of patients and/or their surrogates to donate tissue after WLST. Design: Retrospective cohort study of 368 patients who died in a SNICU in the past 3 years Setting/participants: Twenty-eight adult patients had life-sustaining treatment withdrawn from a total of 368 patients. We analyzed patient demographics and time courses of WLST in SNICU using the Student t-test. Results: Fourteen patients (50%) received surgical interventions, and 19 patients (67.86%) were admitted due to neuro-critical diseases. Tissue procurement for donation is significantly higher in patients underwent surgery than patients without surgery (21% vs. 0%, P=0.041) after the scheduled WLST and consequent verification of cardiac death. Conclusions: Our study uniquely demonstrates that patients who underwent surgical intervention with sufficient time for bidirectional discussions between physicians and the patients’ families were more likely to have tissues donated after WLST. Importantly, tissue donation after WLST is one of the options for end-of-life care in advanced care plan of SNICU.
背景:停止生命维持治疗(WLST)是外科/神经外科重症监护病房(SNICU)危重患者生命末期的一种选择。除了减轻病人的痛苦和安慰代孕者的悲伤，还有一些有意义的事情，比如组织捐赠，让其他人去追求。目的:本研究的目的是探讨手术干预与WLST后患者和/或其代理人捐献组织意愿之间的关系。设计:回顾性队列研究，纳入368例过去3年在SNICU死亡的患者。环境/参与者:从368例患者中撤出28例接受维持生命治疗的成年患者。我们使用学生t检验分析SNICU患者的人口统计学特征和WLST的时间过程。结果:14例(50%)患者接受手术治疗，19例(67.86%)患者因神经危重性疾病入院。在预定的WLST和随后的心源性死亡验证后，接受手术的患者获得用于捐赠的组织明显高于未接受手术的患者(21% vs. 0%， P=0.041)。结论:我们的研究独特地表明，接受手术干预的患者有足够的时间与医生和患者家属进行双向讨论，更有可能在WLST后捐献组织。重要的是，在SNICU的高级护理计划中，WLST后组织捐赠是临终关怀的选择之一。
{"title":"Tissue Donation after Withdrawal of Life-Sustaining Treatment as an Advanced Care Plan is One of the Options in End-of-Life Care","authors":"Chih-Chuan Hsieh, Chiao-Zhu Li, Mengchi Li, Yun-Ju Yang, Kun-Ting Hong, Chi-tun Tang, T. Chung, D. Ju, C. Yeh, Yuan-Hao Chen, Dueng-Yuan Hueng","doi":"10.4172/2165-7386.1000282","DOIUrl":"https://doi.org/10.4172/2165-7386.1000282","url":null,"abstract":"Background: Withdrawal of life-sustaining treatment (WLST) is an option in end-of-life of critical illness in a surgical/neurosurgical intensive care unit (SNICU). In addition to lessen the patient’s suffering and to comfort the surrogates’ grief, there is something meaningful, such as tissue donation, for others to pursue. Aim: The aim of this study is to investigate the relationship between surgical intervention and the willingness of patients and/or their surrogates to donate tissue after WLST. Design: Retrospective cohort study of 368 patients who died in a SNICU in the past 3 years Setting/participants: Twenty-eight adult patients had life-sustaining treatment withdrawn from a total of 368 patients. We analyzed patient demographics and time courses of WLST in SNICU using the Student t-test. Results: Fourteen patients (50%) received surgical interventions, and 19 patients (67.86%) were admitted due to neuro-critical diseases. Tissue procurement for donation is significantly higher in patients underwent surgery than patients without surgery (21% vs. 0%, P=0.041) after the scheduled WLST and consequent verification of cardiac death. Conclusions: Our study uniquely demonstrates that patients who underwent surgical intervention with sufficient time for bidirectional discussions between physicians and the patients’ families were more likely to have tissues donated after WLST. Importantly, tissue donation after WLST is one of the options for end-of-life care in advanced care plan of SNICU.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2016-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-09DOI: 10.4172/2165-7386.1000281
Fusun Terzioğlu, F. Şahan
Gynecologic cancers constitute a significant part of cancer load, especially in developing countries, and may be an important reason for mortality and morbidity for women in these countries. Procedures in diagnosis and treatment for gynecologic cancers might remain insufficient, and disorders related to symptoms may negatively influence the quality of life of women and their families. In this respect, interest on palliative care in gynecologic cancer cases has increased. The literature demonstrates that palliative care allows women to remain active as much as possible in the period between diagnosis and death, aids in management of pain and discomfort during the terminal stage, and ensures a comfortable death process. Palliative care has been shown to improve quality of life, mood, symptom control, satisfaction, survival duration, and caregiver satisfaction, depression, and stress burden. Palliative care improves healthcare utilization outcomes such as decreased hospital costs. Therefore, healthcare provider training and palliative care for patients need to be integrated into standard oncology care.
{"title":"Palliative Care in Gynecologic Cancers","authors":"Fusun Terzioğlu, F. Şahan","doi":"10.4172/2165-7386.1000281","DOIUrl":"https://doi.org/10.4172/2165-7386.1000281","url":null,"abstract":"Gynecologic cancers constitute a significant part of cancer load, especially in developing countries, and may be an important reason for mortality and morbidity for women in these countries. Procedures in diagnosis and treatment for gynecologic cancers might remain insufficient, and disorders related to symptoms may negatively influence the quality of life of women and their families. In this respect, interest on palliative care in gynecologic cancer cases has increased. The literature demonstrates that palliative care allows women to remain active as much as possible in the period between diagnosis and death, aids in management of pain and discomfort during the terminal stage, and ensures a comfortable death process. Palliative care has been shown to improve quality of life, mood, symptom control, satisfaction, survival duration, and caregiver satisfaction, depression, and stress burden. Palliative care improves healthcare utilization outcomes such as decreased hospital costs. Therefore, healthcare provider training and palliative care for patients need to be integrated into standard oncology care.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2016-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000281","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-05DOI: 10.4172/2165-7386.1000280
Rambaud Laurence, Gomas Jean-Marie, R. Michel
Background: Palliative care disclosure and death-facing can be traumatic for patients with advanced cancer. Some of them can suffer a psychotic breakdown that must be differentiated from a terminal delirium. Objectives: To describe a psychiatric side effect from a palliative care announcement called the Alexandrine syndrome. Methods: To illustrate this, we report the case of a patient with no past psychiatric history who, a few days after his palliative state has been announced, presented a major behavioral disorder with violence and paranoiac delusions, heteroagressivity against caregivers and autoagressivity, that could not be explained by a somatic origin. Results: With this case report, we would like to point out the importance of an unreported palliative clinical situation which cannot be explained by an organic substratum. An intense fear of death expressed by the patient with an outburst of defense mechanisms can lead to a brief psychiatric decompensation without any preexisting state of psychosis. Conclusion: The hypothesis of an Alexandrine syndrome should be considered in palliative care in advanced cancer patients experiencing massive anxiety when facing death. This infrequent diagnosis should especially be hypothesized when a patient presents a feature with sudden or recent profound mental disorder following an oncologist consultation with palliative state disclosure. Physical and psychological consequences must not be neglected for patients, as well as disturbing occurrences for the medical team involved. Therefore, oncologists and palliative doctors should be aware of this possibility. Collaboration between psychiatrists and palliative and oncologic teams is recommended to better manage this psychiatric situation.
{"title":"Alexandrine Syndrome and Palliative Care: A Psychotic Reaction against Death: A Case Report","authors":"Rambaud Laurence, Gomas Jean-Marie, R. Michel","doi":"10.4172/2165-7386.1000280","DOIUrl":"https://doi.org/10.4172/2165-7386.1000280","url":null,"abstract":"Background: Palliative care disclosure and death-facing can be traumatic for patients with advanced cancer. Some of them can suffer a psychotic breakdown that must be differentiated from a terminal delirium. Objectives: To describe a psychiatric side effect from a palliative care announcement called the Alexandrine syndrome. Methods: To illustrate this, we report the case of a patient with no past psychiatric history who, a few days after his palliative state has been announced, presented a major behavioral disorder with violence and paranoiac delusions, heteroagressivity against caregivers and autoagressivity, that could not be explained by a somatic origin. Results: With this case report, we would like to point out the importance of an unreported palliative clinical situation which cannot be explained by an organic substratum. An intense fear of death expressed by the patient with an outburst of defense mechanisms can lead to a brief psychiatric decompensation without any preexisting state of psychosis. Conclusion: The hypothesis of an Alexandrine syndrome should be considered in palliative care in advanced cancer patients experiencing massive anxiety when facing death. This infrequent diagnosis should especially be hypothesized when a patient presents a feature with sudden or recent profound mental disorder following an oncologist consultation with palliative state disclosure. Physical and psychological consequences must not be neglected for patients, as well as disturbing occurrences for the medical team involved. Therefore, oncologists and palliative doctors should be aware of this possibility. Collaboration between psychiatrists and palliative and oncologic teams is recommended to better manage this psychiatric situation.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"18 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000280","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-08-25DOI: 10.4172/2165-7386.1000279
Myriam Irislimane, F. Lamontagne, J. You, D. Heyland, L. Brazeau-Lamontagne
Objectives: Goals of care discussions allow seriously ill patients to opt out of technology-laden care, which can improve quality of life at the end of life. In a group of patients with metastatic cancer, we sought to document situations where diagnostic testing might have been avoided. Methods: In this single-center retrospective cohort study, we reviewed the medical records of patients with a known diagnosis of metastatic cancer that were hospitalized between January 1st 2012 and December 31st 2012 and underwent a pulmonary angioscan. We documented level of care prescriptions and treatment plans before and after the test postulating that patients who refused anticoagulation despite a diagnosis of pulmonary embolism might have also refused the pulmonary angioscan if goals of care discussions had encompassed diagnostic procedures. Results: We reviewed the charts of 43 patients who met eligibility criteria. Before the pulmonary angioscan, explicit levels of care were documented for 8 patients (19%). This number increased to 25 (58%) after the test. Of 8 documented levels of care before the pulmonary angioscan, 7 were modified to "comfort measures only" after the test. Three of nine patients (33%) with a pulmonary embolism did not receive anticoagulation. In 2 of the 43 patients (5%), documented discussions about end of life preferences encompassed diagnostic procedures. Conclusions: In a population at high risk of death, documented levels of care were infrequent at hospital admission. Having earlier discussions about end of life preferences encompassing diagnostic procedures may reduce unwanted tests at the end of life.
{"title":"Assessing the Impact of Diagnostic Imaging at the End of Life: A Single-Center Retrospective Cohort Study","authors":"Myriam Irislimane, F. Lamontagne, J. You, D. Heyland, L. Brazeau-Lamontagne","doi":"10.4172/2165-7386.1000279","DOIUrl":"https://doi.org/10.4172/2165-7386.1000279","url":null,"abstract":"Objectives: Goals of care discussions allow seriously ill patients to opt out of technology-laden care, which can improve quality of life at the end of life. In a group of patients with metastatic cancer, we sought to document situations where diagnostic testing might have been avoided. Methods: In this single-center retrospective cohort study, we reviewed the medical records of patients with a known diagnosis of metastatic cancer that were hospitalized between January 1st 2012 and December 31st 2012 and underwent a pulmonary angioscan. We documented level of care prescriptions and treatment plans before and after the test postulating that patients who refused anticoagulation despite a diagnosis of pulmonary embolism might have also refused the pulmonary angioscan if goals of care discussions had encompassed diagnostic procedures. Results: We reviewed the charts of 43 patients who met eligibility criteria. Before the pulmonary angioscan, explicit levels of care were documented for 8 patients (19%). This number increased to 25 (58%) after the test. Of 8 documented levels of care before the pulmonary angioscan, 7 were modified to \"comfort measures only\" after the test. Three of nine patients (33%) with a pulmonary embolism did not receive anticoagulation. In 2 of the 43 patients (5%), documented discussions about end of life preferences encompassed diagnostic procedures. Conclusions: In a population at high risk of death, documented levels of care were infrequent at hospital admission. Having earlier discussions about end of life preferences encompassing diagnostic procedures may reduce unwanted tests at the end of life.","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"2016 1","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2016-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70682960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-30DOI: 10.4172/2165-7386.1000277
In-Fun Li, T. Wang, Fu-Jung Huang, M. Bair, Y. Hsiung
In-Fun Li1,2, Tseng-En Wang3, Fu-Jung Huang2, Ming-Jong Bair4 and Yvonne Hsiung1* 1Department of Nursing, Mackey Medical College, New Taipei City, Taiwan 2Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan 3Division of Gastroenterology, Department of Internal Medicine and Liver Medical Center, Mackay Memorial Hospital, Taipei 4Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taiwan *Corresponding author: Yvonne Hsiung, Department of Nursing, Mackey Medical College, No.46, Sec. 3, Zhongzheng Rd, Sanzhi District, New Taipei City 252, Taiwan, Tel: 886226360606, ext.: 1318; E-mail: yvonnebear@mmc.edu.tw
{"title":"Useful Interview Questions to Promote Spiritual Health: Post-TraumaticAdaptation among Taiwanese Hepatocellular Carcinoma Patients","authors":"In-Fun Li, T. Wang, Fu-Jung Huang, M. Bair, Y. Hsiung","doi":"10.4172/2165-7386.1000277","DOIUrl":"https://doi.org/10.4172/2165-7386.1000277","url":null,"abstract":"In-Fun Li1,2, Tseng-En Wang3, Fu-Jung Huang2, Ming-Jong Bair4 and Yvonne Hsiung1* 1Department of Nursing, Mackey Medical College, New Taipei City, Taiwan 2Department of Nursing, Mackay Memorial Hospital, Taipei, Taiwan 3Division of Gastroenterology, Department of Internal Medicine and Liver Medical Center, Mackay Memorial Hospital, Taipei 4Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taiwan *Corresponding author: Yvonne Hsiung, Department of Nursing, Mackey Medical College, No.46, Sec. 3, Zhongzheng Rd, Sanzhi District, New Taipei City 252, Taiwan, Tel: 886226360606, ext.: 1318; E-mail: yvonnebear@mmc.edu.tw","PeriodicalId":91127,"journal":{"name":"Journal of palliative care & medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7386.1000277","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70683078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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