scholarly journals Impact of Palliative Medicine Involvement on End-of-Life Services for Patients With Cancer With In-Hospital Deaths

2017 ◽  
Vol 13 (9) ◽  
pp. e749-e759 ◽  
Author(s):  
Alison Wiesenthal ◽  
Debra A. Goldman ◽  
Deborah Korenstein
Keyword(s):  
End Of Life ◽  
Solid Tumor ◽  
Diagnostic Testing ◽  
Cancer Center ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Dying Patients ◽  
Hospital Deaths ◽  
Do Not Resuscitate Orders

Purpose: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. Methods: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death. We assessed the differences among services delivered to patients with outpatient PC, inpatient PC only, and no PC involvement. Results: Of 695 patients, 21% received outpatient PC, 46% received inpatient PC only, and 33% received no PC. During their final admission, 11.2% of patients received radiation therapy, and 12.5% received tumor-directed therapy, with no differences on the basis PC involvement ( P = .09 to .17). In the last 3 days of life, imaging tests occurred in 50.1%; patients with outpatient or inpatient-only PC underwent fewer studies (43.5% and 47.3%) than did those with no PC involvement (58.1%; P = .048). Do not resuscitate orders were in place within the 6 months before final admission at a greater rate for patients with outpatient PC (22%) than for patients with inpatient-only PC (8%) or those with no PC involvement (12%; P = .002). Conclusion: In this retrospective cohort of patients with solid tumor dying in hospital, few patients received cancer-directed therapies at the end of life. Involvement of PC was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

“When I Heard the Word Palliative”: Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology

2021 ◽  
pp. OP.21.00088
Author(s):  
Taynara Formagini ◽  
Claire Poague ◽  
Alicia O'Neal ◽  
Joanna Veazey Brooks
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Vital Role ◽  
Cancer Center ◽  
Factors Affecting ◽  
Patients With Cancer ◽  
Social Network Influence ◽  
Qualitative Descriptive ◽  
Cancer Trajectory

PURPOSE Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. METHODS A qualitative descriptive design using grounded theory components was designed to investigate barriers to PC referrals for patients receiving treatment at an outpatient cancer center. Interviews with patients, caregivers, and oncology professionals were audio-recorded, transcribed, and independently coded by three investigators to ensure rigor. Participants were asked about their perceptions of PC and PC referral experiences. RESULTS Interviews with 44 participants revealed both obscuring and clarifying factors surrounding the association of PC as end of life. Prognostic uncertainty, confusion about PC's role, and social network influence all perpetuated an inaccurate and stigmatizing association of PC with end of life. Contrarily, familiarity with PC, prognostic confidence, and clear referral communication helped delineate PC as distinct from end of life. CONCLUSION To reduce the stigmatizing association of PC with end of life, referring clinicians should clearly communicate prognosis, PC's role, and the reason for referral within the context of each patient and his or her unique cancer trajectory. The oncology team plays a vital role in framing the messaging surrounding referrals to PC.

Inpatient care at the end of life: A closer look.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 43-43
Author(s):  
Alison Wiesenthal ◽  
Anabella Lucca Bianchi ◽  
Vinnidhy Dave ◽  
Robert Sidlow ◽  
Susan Seo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Palliative Medicine ◽  
Retrospective Chart Review ◽  
Medication Administration ◽  
Careful Consideration ◽  
Cancer Center ◽  
Inpatient Setting ◽  
Do Not Resuscitate

43 Background: Goals of care discussions in the inpatient setting often focus on the limitation of cardiopulmonary resuscitation and Allow Natural Death (AND) directives; decisions regarding medication administration and further diagnostic studies may be missing from the conversation. De-prescribing at the end of life (EOL) can be emotionally complex for patients and their families, though data is emerging that quality of life may be enhanced by limiting unnecessary medications. Our study assessed care in the last 3 days of life for cancer patients who die in hospital. Methods: Retrospective chart review of all inpatient deaths at a tertiary cancer center between 12/1/2012 and 11/30/2014. The frequency of lab draws, administered medications, and subspecialty consultations during the last 3 days of life were recorded. Results: Of the 1,311 inpatient deaths during the two year study period, 44% had Palliative Medicine consultation. On average, Palliative Medicine was consulted 6.5 days before death, with a median consultation time of 3 days before death. Do not resuscitate (DNR) orders were active for over 80% of patients at the time of death, with an average DNR enacted 4.6 days prior to death (range 0-60 days). Medications most often provided at the end of life were analgesics, fluids, and antibiotics (See Table 1). Consistent with Quality Oncology Practice Initiative (QOPI) Measures, <1% of patients were treated with chemotherapy in the last 3 days of life. Most patients (85%) had laboratory tests in their final 3 days of life, with a mean of 21 orders per patient. Conclusions: Non-palliative services are often provided to hospitalized patients at the end of life. Careful consideration must be given to the potential benefits and harms of medical interventions at the EOL to improve quality of life for the dying patient. Further research is needed to understand the drivers behind the care provided at EOL to inform educational tools for clinicians. [Table: see text]

Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

2021 ◽  
Author(s):  
A McCauley Massie ◽  
Jonathan Ebelhar ◽  
Kristen E Allen ◽  
Nicholas P DeGroote ◽  
Karen Wasilewski-Masker ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
End Of Life ◽  
Phase 1 ◽  
Marrow Transplant ◽  
Cns Tumors ◽  
Do Not Resuscitate ◽  
Intensive Care Admission ◽  
Repeated Events

Abstract Background Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown. Methods A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between 01/01/2012-11/30/2017. Nine palliative opportunities were defined prior to data collection (progression; relapse; admission for severe symptoms; intensive care admission; bone marrow transplant; phase 1 trial; hospice; do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death. Results Amongst 101 patients with a median age at death of eight years (Interquartile range, IQR=8.0, range 0-22), there was a median of seven (IQR=6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (p=0.0028). Hospice was involved for 72 (71.3%) patients. Conclusion Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.

scholarly journals Fears, beliefs, and quality of life of patients with cancer vs the general population during the coronavirus disease 2019 (COVID-19) pandemic in Lombardy

2021 ◽  
pp. 030089162110228
Author(s):  
Carla Ida Ripamonti ◽  
Giacomo Massa ◽  
Daniela Insolvibile ◽  
Mauro Guglielmo ◽  
Guido Miccinesi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Perceived Risk ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Psychological Consequences ◽  
Patients With Cancer ◽  
Fear Of Cancer

Aim: To understand how patients with cancer reacted to the coronavirus disease 2019 (COVID-19) pandemic and whether their quality of life (QoL) was affected. Methods: In June 2020, 111 patients with cancer treated in the supportive care unit of a Comprehensive Cancer Center in Milan and 201 healthy controls from the general population were enrolled and assessed both quantitatively and qualitatively for fears and COVID-19–related beliefs as well as for QoL. Results: Fear of COVID-19 was significantly lower among patients (41% vs 57.6%; p = 0.007), as was fear of cancer (61.5% vs 85.6%; p < 0.001) and other diseases. The perceived risk of getting COVID-19 was lower among patients (25.2% vs 52.7%; p < 0.001), as was the belief of having been exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (18.1% vs 40.8%; p < 0.001). The physical component of QoL was better among the population (54.5 vs 43.8; p < 0.001); the reverse was true for patients’ psychological well-being (44.6 vs 39.6; p < 0.001). The qualitative data supported such results, showing a reduced psychological effect on the patients with cancer compared to the controls. Various reasons explain this result, including the awareness of being treated for cancer and nevertheless protected against getting infected in a cancer center of public health reorganized to continue treating patients by protecting them and personnel from the risk of infection. Conclusions: The experience of a cancer diagnosis, together with proper hospital reorganization, may act as protective factors from fears and psychological consequences of the COVID-19 outbreak.

Provider and Patient Gender Influence on Timing of Do-Not-Resuscitate Orders in Hospitalized Patients with Cancer

2016 ◽  
Vol 19 (7) ◽  
pp. 728-733 ◽  
Author(s):  
Melissa A. Crosby ◽  
Lee Cheng ◽  
Alma Y. DeJesus ◽  
Elizabeth L. Travis ◽  
Maria A. Rodriguez
Keyword(s):  
Hospitalized Patients ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Gender Influence ◽  
Patient Gender ◽  
Do Not Resuscitate Orders

scholarly journals Perception of Iranian Patients with Cancer, Their Relatives, and Health Care Professionals Towards Length of Life and Quality of Life: A Local Survey

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Negin Nourbakhsh ◽  
Bahareh Tahani ◽  
Azadeh Moghaddas
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Survival Time ◽  
Health Care Professionals ◽  
Treatment Modalities ◽  
Cancer Center ◽  
Treatment Choices ◽  
Patients With Cancer ◽  
Length Of Life

Background: Recently, therapeutic decision-making in oncology is changed to a big challenge for both patients and involved oncologists due to an increase in available treatment modalities with a variety of benefits or adverse effects. Objectives: The current study aimed at comparing the perception of treatment priorities regarding lengthening of survival time or maintenance of the quality of life (QoL) among patients with cancer by health care professionals (HCPs). Methods: The current cross-sectional study was conducted on patients with cancer, their relatives, and healthcare professionals in the referral cancer center of Omid affiliated to Isfahan University of Medical Sciences. To identify treatment choices, priority, and related variables influencing their opinions, all participants were interviewed using a standard and valid questionnaire in Persian. The collected data were analyzed using the SPSS software version 20, and the P-value less than 0.05 was considered statistically significant. Results: A total of 299 participants, including 100 patients, 109 relatives, and 90 HCPs (74.2% nurses, 20.2% physicians, 5.6% others) participated in the study. The priority of treatment between survival time (66.1% for relatives vs. 47.9% for patients and 21.3% for HCP) and QoL (33.9% vs.52.1% and 78.7%) was significantly different between the three groups (P < 0.001). Most of the HCPs, patients, and their relatives believed that the physician is the only person who should accept the responsibility of treatment choices and process (98.9% vs. 100% and 98%, respectively; P = 0.002). Conclusions: Among the Iranian population, both the length of life and QoL were valuable; however, it was observed that patients with cancer and HCPs preferred mostly to expand the QoL, while the length of life was more valuable for relatives. Also, all patients, their relatives, and HCPs preferred to choose the physicians as the decision-makers. The results of the study can be helpful in choosing treatment regimens and designing clinical trials.

Developing a national quality register in end-of-life care: The Swedish experience

2011 ◽  
Vol 26 (4) ◽  
pp. 313-321 ◽  
Author(s):  
Staffan Lundström ◽  
Bertil Axelsson ◽  
Per-Anders Heedman ◽  
Greger Fransson ◽  
Carl Johan Fürst
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care ◽  
Quality Register ◽  
Dying Patients ◽  
National Quality ◽  
Hospital Wards ◽  
National Quality Register

Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

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