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Identifying Prevalence and Potential Predictors of Do-Not-Attempt-Resuscitation Orders to Facilitate Preoperative Discussions on Code Status. 识别 "不尝试复苏 "命令的普遍性和潜在预测因素,以促进术前关于代码状态的讨论。
Pub Date : 2025-04-01 Epub Date: 2024-07-30 DOI: 10.1177/10499091241268589
Kelly Cheung, Alex Saffran, Ashton Engdahl, Benjamin Chiang, Joseph Boyle, Perry Taylor, Paul Murphy

Background: Do Not Attempt Resuscitation (DNAR) orders allow patients with life-threatening conditions to decline resuscitation efforts should the need arise. The American Society of Anesthesiologists (ASA) recommends discussions with patients on their code status to clarify and honor their goals of care perioperatively. This project sought to determine the prevalence of DNAR orders and to identify the demographics and potential clinical predictors of DNAR status at the beginning and end of admission, which would help anesthesiologists at our center facilitate these discussions.

Methods: Factors associated with DNAR status at beginning and at end of hospital stay were determined through univariate logistic regressions. For DNAR status at beginning and end of hospital admission, variables assessed were age at arrival, race, sex, palliative consult, use of palliative care service, length of stay in days, presence of surgery, presence of emergent surgery, care level, and medical service.

Results: Approximately 2.4 percent of the sample had an active DNAR order at the beginning of their hospital admission compared to 7.4 percent at the end of hospital admission. Factors significantly associated with DNAR status at the beginning of the hospital stay were consistent with prior literature (age, palliative care consult or service). However, factors significantly associated with DNAR status at the end of hospital stay that were notable included length of stay, undergoing emergent surgery, higher level of care, and being on the oncology service and medical respiratory intensive care unit.

Conclusions: This retrospective study allows anesthesiologists at our institution to identify patients who may benefit from a more comprehensive perioperative discussion about code status based on certain clinical characteristics, which may improve quality of care by preventing unwanted resuscitative measures that do not align with a patient's goals of care.

背景:不尝试复苏(DNAR)指令允许有生命危险的患者在需要时拒绝复苏努力。美国麻醉医师协会(ASA)建议与患者讨论他们的代码状态,以明确并尊重他们围手术期的护理目标。本项目旨在确定 DNAR 命令的普遍性,并识别入院开始和结束时 DNAR 状态的人口统计学特征和潜在临床预测因素,这将有助于我们中心的麻醉医师促进这些讨论:通过单变量逻辑回归确定了与住院开始和结束时的 DNAR 状态相关的因素。对于入院开始和结束时的 DNAR 状态,评估的变量包括入院时的年龄、种族、性别、姑息咨询、姑息治疗服务的使用、住院天数、是否手术、是否紧急手术、护理级别和医疗服务:结果:约有 2.4% 的样本在入院之初就下达了有效的 DNAR 令,而在入院结束时,这一比例为 7.4%。与住院之初的 DNAR 状态明显相关的因素与之前的文献(年龄、姑息治疗咨询或服务)一致。然而,与住院结束时的DNAR状态明显相关的因素包括住院时间长、接受紧急手术、护理级别较高、在肿瘤科和呼吸内科重症监护室:通过这项回顾性研究,本机构的麻醉医师可以根据某些临床特征确定哪些患者可能受益于围术期更全面的代码状态讨论,从而避免采取与患者护理目标不符的不必要抢救措施,提高护理质量。
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引用次数: 0
Doctor Facilitated Denial: A Barrier to Advance Care Planning Among COPD Patients.
Pub Date : 2025-03-04 DOI: 10.1177/10499091251325800
Lauren Seidman, Negin Hajizadeh

Background: Many severe COPD patients are unaware of their treatment options and lack motivation for advance care planning. It is crucial to increase patient awareness regarding their chronic conditions.

Methods: The InformedTogether decision aid was used in outpatient clinical visits to inform patients about their COPD prognosis. Audio-recorded visits were analyzed for how denial, self-perceived health, and trust impacted patient motivation to make an advance care plan.

Results: Of the 26 patients, 4 (15.38%) showed an increase in motivation, 20 (76.92%) had no change, and 2 (7.69%) showed a decrease in motivation. Denial facilitated by physicians did not significantly affect motivation (p = 0.543). Self-perceived health also had no significant impact on motivation, with 68.00% rating their health as poor, 16.00% as fair, and 16.00% as good (p = 0.847). Trust in the physician's information was generally high, with 64.00% reporting high trust, but did not lead to an increase in motivation (p = 0.512).

Conclusion: Denial, self-perceived health, and trust did not significantly affect patient motivation to make an advance care plan. This study suggests that barriers to increasing motivation remain, and further research on external factors may be helpful to improve patient participation in end-of-life care planning.

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引用次数: 0
Impact of Implementing Serious Illness Conversations Across a Comprehensive Cancer Center Using an Interdisciplinary Approach. 综合癌症中心采用跨学科方法开展重病对话的影响。
Pub Date : 2025-03-01 Epub Date: 2024-05-10 DOI: 10.1177/10499091241252058
Karen Guo, Garrett Wasp, Maxwell Vergo, Matthew Wilson, Megan M Holthoff, Madge E Buus-Frank, James J Perry, Amelia M Cullinan

Background: Gaps in communication of end-of-life care preferences increase risk of patient harm. Adoption of oncology practice guidelines advocating serious illness communication for patients with advanced cancer is limited.

Objectives: (1) Increase Serious Illness Conversation (SIC) use across oncology teams via an interdisciplinary quality improvement (QI) approach and (2) assess patient reported shared decision making (SDM) experiences with clinicians engaged in SIC implementation.

Design: QI methodology was applied to spread the implementation of SIC across 4 oncology teams. CollaboRATE scores were used to evaluate patient reported outcomes of SDM for patients with advanced cancer.

Settings/subjects: The SIC QI initiative was a component of the Promise Partnership Learning Health System (PPLHS) piloted in the Dartmouth Cancer Center, Lebanon, NH, USA.

Measurements: (1) The percentage of eligible patients with documented SIC and (2) a comparison of a patient reported measure of SDM (CollaboRATE) among SIC eligible patients in encounters with providers who took part in the implementation versus those who did not.

Results: Oncology teams screened a total of 538 patients, identified 278 eligible patients, and completed 144 SIC conversations. The teams improved the proportion of documented SIC among eligible patients from near 0% to a collective frequency of 52%. For clinicians' top-box CollaboRATE scores, a chi-squared test demonstrated a statistically significant association between providers implementing SIC into practice and patient reported shared decision making (.16, p = .031).

Conclusions: This approach allows for tailoring of iterative improvement cycles to mitigate barriers and improve the practice of SIC among oncology teams.

背景:临终关怀偏好沟通方面的不足会增加对患者造成伤害的风险。目标:(1) 通过跨学科质量改进(QI)方法,提高肿瘤团队对重病沟通(SIC)的使用率;(2) 评估患者报告的与参与实施重病沟通的临床医生共同决策(SDM)的经验:设计:采用 QI 方法在 4 个肿瘤团队中推广实施 SIC。采用 CollaboRATE 评分来评估晚期癌症患者的 SDM 患者报告结果:SIC QI 计划是美国新罕布什尔州黎巴嫩达特茅斯癌症中心试点的 Promise Partnership Learning Health System (PPLHS) 的一个组成部分:(测量指标:(1)有 SIC 记录的符合条件的患者比例;(2)患者报告的 SDM 测量指标(CollaboRATE)在与参与实施和未参与实施的医疗服务提供者接触的符合 SIC 条件的患者中的比较:肿瘤团队共筛查了 538 名患者,确定了 278 名符合条件的患者,并完成了 144 次 SIC 对话。在符合条件的患者中,这些团队将记录在案的 SIC 比例从接近 0% 提高到了 52%。对于临床医生的顶格 CollaboRATE 分数,卡方检验表明,医疗服务提供者在实践中实施 SIC 与患者报告的共同决策之间存在统计学意义上的显著关联(.16,p = .031):这种方法可以调整迭代改进周期,以减少障碍并改善肿瘤团队的 SIC 实践。
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引用次数: 0
Patterns of Palliative Care Consultation in Neurosurgical Patients. 神经外科患者的姑息治疗咨询模式。
Pub Date : 2025-03-01 Epub Date: 2024-05-17 DOI: 10.1177/10499091241255349
Sawyer Kieffer, John Arce, Amy Ogilvie, Hiroyuki Oya, Yuya Hagiwara

Numerous neurosurgical (NSG) conditions entail high morbidity, mortality, and prolonged ICU stays. Palliative care (PC) serves to alleviate suffering, align treatment with patient preferences, and is linked to enhanced patient and family outcomes as well as reduced care costs. Notably, no studies have addressed demographic and clinical factors associated with PC receipt in NSG patients. Our aim is to identify characteristics and outcomes, particularly end of life outcomes, of hospitalized NSG patients associated with a PC consult compared with usual NSG care. A retrospective chart review was performed of patients admitted to the NSG service from January 1, 2017 to December 31, 2018 at the University of Iowa Hospitals & Clinics. Data regarding demographics, clinical outcomes, and GOC and ACP documentation were collected. The most common reasons for a PC consult were goals of care, end of life issues, and comfort care. Of 121 total decedent patients, 97 (80.2%) had PC referrals. Patients with a PC referral had longer hospital stays (10.3 days vs 4 days) and had the majority of care in the ICU (90.7% vs 83.3%). However, fewer PC patients died in the ICU (42.3% vs 75%) and more had PCA/NCA use (51.5% vs 8.3%), code status changes to DNR (90.7% vs 62.5%), GOC documented (78.4% vs 0%) and ACP documentation (35.1% vs 16.7%). In conclusion, in NSG patients, the integration of PC may contribute to improved end-of-life care.

许多神经外科(NSG)疾病都会导致高发病率、高死亡率和延长重症监护室的住院时间。姑息治疗(PC)可减轻患者的痛苦,使治疗符合患者的偏好,并可提高患者和家属的治疗效果,降低护理成本。值得注意的是,目前还没有研究探讨与 NSG 患者接受姑息治疗相关的人口统计学和临床因素。我们的目的是确定与常规 NSG 护理相比,接受 PC 咨询的住院 NSG 患者的特征和预后,尤其是生命末期的预后。我们对爱荷华大学医院与诊所在 2017 年 1 月 1 日至 2018 年 12 月 31 日期间接受 NSG 服务的患者进行了回顾性病历审查。收集了有关人口统计学、临床结果以及 GOC 和 ACP 文档的数据。PC咨询最常见的原因是护理目标、生命末期问题和舒适护理。在 121 名死者患者中,97 人(80.2%)接受了 PC 转诊。经 PC 转诊的患者住院时间较长(10.3 天对 4 天),大部分患者在重症监护室接受护理(90.7% 对 83.3%)。但是,在重症监护室死亡的 PC 患者人数较少(42.3% 对 75%),使用 PCA/NCA 的患者人数较多(51.5% 对 8.3%),代码状态变更为 DNR 的患者人数较多(90.7% 对 62.5%),有 GOC 记录的患者人数较少(78.4% 对 0%),有 ACP 记录的患者人数较多(35.1% 对 16.7%)。总之,对于 NSG 患者,整合 PC 可能有助于改善临终关怀。
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引用次数: 0
Inpatient Palliative Care and Healthcare Utilization Among Older Patients With Alzheimer's Disease and Related Dementia (ADRD) and High Risk of Mortality in U.S. Hospitals. 美国医院中阿尔茨海默病及相关痴呆症 (ADRD) 和高死亡率风险老年患者的住院姑息治疗和医疗服务使用情况。
Pub Date : 2025-03-01 Epub Date: 2024-05-06 DOI: 10.1177/10499091241252685
Zhigang Xie, Guanming Chen, Oluwadamilola T Oladeru, Hanadi Y Hamadi, Lucinda Montgomery, Maisha T Robinson, Young-Rock Hong

Background. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). Methods. Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). Results. Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65 years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 (p trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all P < .05). Although patients who received PC were more likely to have 3.0% longer LOS (P < .001), they had 19.2% lower hospital charges (P < .001). Conclusions. PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.

背景。尽管姑息治疗(PC)具有提高晚期痴呆症患者生活质量的潜力,但人们对其住院利用模式的了解却很有限。本研究调查了阿尔茨海默病及相关痴呆症老年高危患者(ADRD-HRM)的住院姑息治疗咨询使用模式,并评估了其对住院时间(LOS)和医疗费用的影响。研究方法利用 2016-2019 年全国住院患者样本数据库,我们进行了多变量逻辑回归分析,以确定影响 PC 咨询利用率的个人和医院特征。随后,我们使用广义线性模型估算了LOS(使用泊松分布)和医院收费(通过对数变换)。结果。我们的样本涵盖了 965,644 例出院患者(加权 n = 4,828,219 例),这些患者均为 65 岁及以上的 ADRD-HRM 患者。其中,14.6%的患者接受了住院PC治疗。PC就诊率从2016年的13.3%上升到2019年的16.3%,呈明显上升趋势(P趋势P < .05)。虽然接受 PC 治疗的患者更有可能延长 3.0% 的 LOS(P < .001),但他们的住院费用却降低了 19.2%(P < .001)。结论。PC大大降低了患有ADRD-HRM的老年患者的住院费用,但研究期间的患病率仍然很低,仅为14.6%。今后的研究应探讨社会人口学地位较低的患者和农村医院患者未得到满足的需求,以进一步提高他们的 PC 咨询利用率。
{"title":"Inpatient Palliative Care and Healthcare Utilization Among Older Patients With Alzheimer's Disease and Related Dementia (ADRD) and High Risk of Mortality in U.S. Hospitals.","authors":"Zhigang Xie, Guanming Chen, Oluwadamilola T Oladeru, Hanadi Y Hamadi, Lucinda Montgomery, Maisha T Robinson, Young-Rock Hong","doi":"10.1177/10499091241252685","DOIUrl":"10.1177/10499091241252685","url":null,"abstract":"<p><p><i>Background</i>. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). <i>Methods</i>. Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). <i>Results</i>. Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65 years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 (<i>p</i> trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all <i>P</i> < .05). Although patients who received PC were more likely to have 3.0% longer LOS (<i>P</i> < .001), they had 19.2% lower hospital charges (<i>P</i> < .001). <i>Conclusions</i>. PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.</p>","PeriodicalId":94222,"journal":{"name":"The American journal of hospice & palliative care","volume":" ","pages":"261-272"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870738","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}
引用次数: 0
Analysis of Barriers to Medical Opioid Pain Medication Using the Japanese Version of the Barriers Questionnaire II (JBQ-II): Pharmacists and Nurses Perspective in Japan. 使用日文版障碍问卷 II (JBQ-II)分析使用阿片类止痛药物的障碍:日本药剂师和护士的观点。
Pub Date : 2025-03-01 Epub Date: 2024-05-09 DOI: 10.1177/10499091241252841
Yugo Chisaki, Mika Oomoto, Yuika Sakurano, Takashi Imanishi

Background: Some Japanese patients with cancer pain have negative beliefs regarding opioid therapy. The Japanese version of the Barriers Questionnaire II (JBQ-II) determines barriers to cancer pain management. Few studies reported JBQ-II scores in Japan, and none focused on pharmacists. Accordingly, we aimed to explore the relationship between health care professionals' knowledge of and willingness to use opioids, and their JBQ-II scores. Additionally, the variances in JBQ-II scores among nurses, hospital pharmacists, and pharmacy pharmacists were assessed.

Methods: This cross-sectional survey employed the JBQ-II for nurses and pharmacists in hospitals and pharmacies across Japan. Participants were requested to respond to the JBQ-II concerning their affiliation, knowledge of opioid analgesics, and willingness to utilize these drugs for medical practice.

Results: A total of 55 hospital pharmacists, 25 pharmacy pharmacists, and 24 nurses responded to the survey. The group-knowledgeable about medical use of narcotics had significantly lower total JBQ-II scores (25.43, standard deviation [SD]: 15.11) than those had by the group with insufficient knowledge (34.50, SD: 18.41). There was no statistically significant difference in total JBQ-II scores among those willing to use opioids medically. The total JBQ-II scores of hospital pharmacists, pharmacy pharmacists, and nurses were 31.00 (SD: 15.11), 33.96 (SD: 19.25), and 27.21 (SD: 15.56), respectively. However, the differences were not statistically significant.

Conclusions: Health care professionals in Japan with knowledge about opioids for medical purposes had a significantly lower total JBQ-II score than those with insufficient knowledge. Thus, health care professionals' knowledge plays a crucial role in reducing barriers to using narcotic drugs.

背景:一些日本癌痛患者对阿片类药物治疗持消极看法。日语版障碍问卷 II(JBQ-II)可确定癌症疼痛治疗的障碍。在日本,很少有研究报告 JBQ-II 的得分,也没有研究关注药剂师。因此,我们旨在探讨医护人员对阿片类药物的了解和使用意愿与他们的 JBQ-II 分数之间的关系。此外,我们还评估了护士、医院药剂师和药房药剂师的 JBQ-II 分数差异:这项横断面调查采用了 JBQ-II,调查对象是日本各地医院和药房的护士和药剂师。要求参与者就其所属机构、对阿片类镇痛药的了解以及在医疗实践中使用这些药物的意愿回答 JBQ-II:共有 55 名医院药剂师、25 名药房药剂师和 24 名护士参与了调查。对麻醉药品的医疗使用有了解的一组的 JBQ-II 总分(25.43,标准差 [SD]:15.11)明显低于了解不足的一组(34.50,标准差:18.41)。愿意医疗使用阿片类药物者的 JBQ-II 总分在统计学上没有明显差异。医院药剂师、药房药剂师和护士的 JBQ-II 总分分别为 31.00(标准差:15.11)、33.96(标准差:19.25)和 27.21(标准差:15.56)。然而,这些差异在统计学上并不显著:结论:在日本,了解医用阿片类药物知识的医护人员的 JBQ-II 总分明显低于知识不足的医护人员。因此,医护人员的知识在减少使用麻醉药品的障碍方面起着至关重要的作用。
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引用次数: 0
Disparities in Palliative Care Use for Patients With Blood Cancer Who Died in the Hospital. 死于医院的血癌患者在使用姑息治疗方面的差异。
Pub Date : 2025-03-01 Epub Date: 2024-05-27 DOI: 10.1177/10499091241254523
Tien-Chan Hsieh, Yee Hui Yeo, Guangchen Zou, Chan Zhou, Arlene Ash

Background: Palliative care can enhance quality of life during a terminal hospitalization. Despite advances in diagnostic and treatment tools, blood cancers lag behind solid malignancies in palliative use. It is not clear what factors affect palliative care use in blood cancer. Methods: We used the 2016 to 2019 National Inpatient Sample to identify demographic and socioeconomic factors associated with receiving palliative care among patients over age 18 with any malignant hematological diagnosis during a terminal hospitalization lasting at least 3 days, excluding those receiving a stem cell transplant. Results: Palliative care use was documented 54% of the time among 49,720 weighted cases (9944 distinct individual hospitalizations), approximately evenly distributed across the years 2016-2019. Palliative care use was lowest in 2016 (51%) and highest in 2018 (58%), and increased with age, reaching 58% for those 80 years and older. Men and women were similarly likely to receive care. Patients of Hispanic ethnicity and African Americans received less palliative care (47% and 49%, respectively), as did those insured by Medicaid (48%), and those admitted to small or rural hospitals (52% and 47%, respectively). Charges for hospitalizations with palliative care were 19% lower than for those without it. Conclusions: This study highlights disparities in palliative care use among blood-cancer patients who died in the hospital. It seems likely that many of the 46% who did not receive palliative care could have benefitted from it. Interventions are likely needed to achieve equitable access to ideal levels of palliative care services in late-stage blood cancer.

背景介绍姑息治疗可以提高临终住院期间的生活质量。尽管诊断和治疗工具不断进步,但血液癌症在姑息治疗方面仍落后于实体恶性肿瘤。目前尚不清楚哪些因素会影响血液癌患者使用姑息治疗。方法:我们利用2016年至2019年全国住院患者样本,确定了18岁以上任何恶性血液病诊断患者在至少3天的临终住院期间接受姑息治疗的相关人口和社会经济因素,其中不包括接受干细胞移植的患者。研究结果在49720个加权病例(9944个不同的住院病例)中,有54%的病例记录了姑息治疗的使用,这些病例在2016-2019年间大致均匀分布。使用姑息治疗的比例在 2016 年最低(51%),在 2018 年最高(58%),并且随着年龄的增长而增加,80 岁及以上的患者使用姑息治疗的比例达到 58%。男性和女性接受姑息治疗的可能性相似。西班牙裔和非裔美国人患者接受姑息关怀的比例较低(分别为47%和49%),医疗补助(Medicaid)保险患者(48%)和小型或农村医院住院患者(分别为52%和47%)也是如此。接受姑息治疗的住院病人的费用比未接受姑息治疗的住院病人低 19%。结论:本研究强调了在医院死亡的血癌患者在使用姑息治疗方面的差异。在46%未接受姑息治疗的患者中,有许多人本可从中受益。要使晚期血癌患者公平地获得理想水平的姑息治疗服务,可能需要采取干预措施。
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引用次数: 0
Attention to the Values, Wishes and Needs of Patients With Advanced Cancer by Hospital Clinicians, an Exploratory Qualitative Study. 医院临床医生对晚期癌症患者的价值观、愿望和需求的关注,一项探索性定性研究。
Pub Date : 2025-03-01 Epub Date: 2024-06-18 DOI: 10.1177/10499091241261025
Sita de Vries, Laury Pijnappel, Sigrid Vervoort, Yvette van der Linden, Saskia Teunissen, Everlien de Graaf

Context: Insight into patients' personal values, wishes, and needs (VWN) by clinicians is essential to guide appropriate palliative care. Objective: To gain insight into the exploration and monitoring of the VWN of patients with advanced cancer during the illness trajectory by hospital oncology clinicians. Method: A generic qualitative study was conducted from February 2022 to July 2022. Specialized nurses, nurse practitioners and medical specialists (in training) providing care to adult patients with advanced cancer were recruited at an outpatient clinic in a Dutch academic hospital. Data were collected using in-depth semi-structured interviews and participatory observations of outpatient clinic consultations. Data were analyzed collaboratively by two researchers using thematic analysis. Results: Eleven clinicians, aged 33-64, 8 females, participated; 7 interviews and 13 observations were conducted. How clinicians explored and monitored patients' VWN was based on their opinions, originating from the clinicians' personal values and work experiences. These were influenced by the local collaboration. Three key opinions were identified: (1) providing safety, (2) supporting medical decision-making, and (3) ensuring alignment. Individual clinicians' approaches varied. The alignment of care and treatment with the patient's VWN was observed to be limited. Conclusion: Clinicians acknowledged the importance of exploring and monitoring patients' VWN but lacked a systematic approach in discussing these topics. Patients should be actively engaged in communication regarding their VWN rather than primarily being provided with medical information. Patient-Reported Outcome Measures may be beneficial in facilitating communication regarding the patient's VWN and could improve appropriate palliative care in hospital cancer care.

背景:临床医生洞察患者的个人价值观、愿望和需求(VWN)对于指导适当的姑息治疗至关重要。研究目的深入了解医院肿瘤科临床医生对晚期癌症患者在患病过程中的个人价值取向(VWN)的探索和监测。方法:从 2012 年 2 月开始进行一项通用定性研究:从 2022 年 2 月至 2022 年 7 月开展了一项通用定性研究。在荷兰一家学术医院的门诊部招募了为晚期癌症成年患者提供护理服务的专科护士、执业护士和医学专家(正在接受培训)。通过深入的半结构式访谈和对门诊咨询的参与式观察收集数据。两名研究人员采用主题分析法对数据进行了合作分析。研究结果11 名临床医生(33-64 岁,8 名女性)参与了研究;共进行了 7 次访谈和 13 次观察。临床医生如何探索和监测患者的 VWN,取决于他们的意见,这些意见源自临床医生的个人价值观和工作经验。这些都受到当地合作的影响。确定了三个主要观点:(1) 提供安全性,(2) 支持医疗决策,以及 (3) 确保一致性。每个临床医生的做法各不相同。据观察,护理和治疗与患者大众健康网的一致性有限。结论:临床医生认识到探索和监测患者自愿观察网的重要性,但在讨论这些主题时缺乏系统的方法。患者应积极参与有关其 VWN 的交流,而不是主要向其提供医疗信息。患者报告结果衡量标准可能有助于促进有关患者自愿放弃治疗的沟通,并可改善医院癌症护理中适当的姑息治疗。
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引用次数: 0
End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias. 阿尔茨海默氏症和其他痴呆症患者的临终关怀。
Pub Date : 2025-03-01 Epub Date: 2024-05-07 DOI: 10.1177/10499091241253838
Darlon Jan, Kye Y Kim

End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).

生命末期护理(EOL)一直是癌症等绝症患者的常见选择。然而,生命末期护理在阿尔茨海默病和其他痴呆症中的应用则相对较晚。随着痴呆症晚期的临近,临床医生和护理人员面临着众多临床挑战--谵妄、神经行为症状、患者无法表达疼痛和相关不适、拒食等。除了为临终患者提供优质的临床护理外,临床医生还应特别关注患者家属,确保他们的亲人能够得到支持性措施,以提高生活质量(QOL)。
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引用次数: 0
A Phase II Study About Efficacy and Safety of the Continuous IntraVenous Infusion of Ketamine as Adjuvant to Opioids in Terminally Ill Cancer Patients With Refractory Cancer Pain (CIVIK Trial). 关于静脉内持续输注氯胺酮作为阿片类药物辅助治疗晚期难治性癌痛患者的疗效和安全性的 II 期研究(CIVIK 试验)。
Pub Date : 2025-03-01 Epub Date: 2024-05-16 DOI: 10.1177/10499091241252977
Kwonoh Park, Jae-Joon Kim, Sang-Bo Oh, So Yeon Oh, Yun Jeong Hong, Seo-Jun Kim, Eun-Ju Park, Nayeon Choi, Seon-Hi Shin, Sungeun Kim, Heejung Ko

Background: Ketamine has been used to control refractory cancer pain as an adjuvant to opioids. We conducted a prospective phase II study to investigate the efficacy and safety of 5-day continuous intravenous infusion (CIVI) of Ketamine in terminally ill cancer patients with refractory cancer pain.

Methods: Hospitalized terminally ill cancer patients with refractory cancer pain were enrolled. Refractory cancer pain was indicated by requirements for 4 or more rescue opioids or pain intensity using numerical rating scale > personalized pain goal (PPG) despite of intravenous morphine equivalent daily dose (IV MEDD) ≥ 120 mg/day. The CIVI of ketamine was increased from .05 mg/kg/hour to .5 mg/kg/hour by .05 every 8 hours if pain intensity exceeded PPG or if number of rescue opioids ≥2 during prior 8 hours was required. The primary end-point was overall pain response rate, which indicates complete response (both rescue opioid ≤3/day and pain intensity ≤ PPG) plus partial response (rescue opioid ≤3/day), without unacceptable toxicities.

Results: Among 21 eligible patients enrolled between September 2019 and January 2023, 20 were analyzed. Most pain mechanisms were mixed type (n = 15, 75%), with neuropathic component (n = 17, 85%). The baseline background opioids were IV MEDD 186 mg/24hour (range, 124-592), number of rescue opioids was 6 (IQR, 5-9), and median PPG was 4 (IQR, 3-4). The overall pain response rate was 50% (n = 10) including 40% (n = 8) for complete pain response and 10% (n = 2) for partial pain response.

Conclusion: This study showed efficacy of gradually increasing CIVI of ketamine for terminally ill cancer patients with refractory cancer pain. CIVI of ketamine could be a useful tool in these patients considering the limited treatment options. (NCT03362073, Initial Release: November 15, 2017).

背景:氯胺酮作为阿片类药物的辅助药物已被用于控制难治性癌痛。我们开展了一项前瞻性 II 期研究,调查氯胺酮 5 天连续静脉输注(CIVI)在患有难治性癌痛的晚期癌症患者中的疗效和安全性。难治性癌痛的指征是:尽管静脉注射吗啡等效日剂量(IV MEDD)≥ 120 毫克/天,但仍需使用 4 种或更多阿片类药物或使用数字评分量表进行疼痛强度评分 > 个性化疼痛目标(PPG)。如果疼痛强度超过 PPG,或在前 8 小时内需要使用的阿片类药物≥2 次,氯胺酮的 CIVI 将从 0.05 毫克/千克/小时增加到 0.5 毫克/千克/小时,每 8 小时增加 0.05 毫克。主要终点是总体疼痛反应率,即完全反应(救援阿片类药物≤3/天且疼痛强度≤PPG)加部分反应(救援阿片类药物≤3/天),且无不可接受的毒性反应:在2019年9月至2023年1月期间入组的21名符合条件的患者中,对20名患者进行了分析。大多数疼痛机制为混合型(15 人,75%),其中有神经病理性成分(17 人,85%)。基线背景阿片类药物为静脉注射 MEDD 186 毫克/24 小时(范围为 124-592),救援阿片类药物的数量为 6(IQR,5-9),PPG 中位数为 4(IQR,3-4)。总体疼痛反应率为 50%(n = 10),其中完全疼痛反应率为 40%(n = 8),部分疼痛反应率为 10%(n = 2):本研究表明,逐渐增加氯胺酮 CIVI 对患有难治性癌痛的晚期癌症患者具有疗效。考虑到治疗方案有限,氯胺酮CIVI对这些患者可能是一种有用的工具。(NCT03362073,初次发布:2017年11月15日)。
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引用次数: 0
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The American journal of hospice & palliative care
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