The Impact of a Family-Friendly Hospital: A Patient Perspective.

INTRODUCTION: When a seriously ill and dying parent is hospitalized, the families are at risk of developing problems. Only sparse evidence is available on the effects of creating family-friendly rooms in hospitals. AIM: This study investigates how a seriously ill parent to children aged 0-18 experiences staying in a hospital room with family-friendly furnishing. METHODS: From September 2012 to September 2015, seriously ill and dying patients with children ages 0-18 were offered the opportunity to stay in a family-friendly room at the North Denmark Regional Hospital. The sick parents were interviewed about how the changed room impacted themselves, their children, and their family. RESULTS: The analysis led to three themes: (1) The ability to visit a sick parent, (2) maintaining family functions and relationships, and (3) room for children and adults. CONCLUSION: By offering the families a hospital room with cozy furniture and a big TV screen, seriously ill parents see that their children are more comfortable when visiting the hospital. A family-friendly hospital is not just an idealistic thought, it is a real opportunity to improve the final period of a dying parent's life.

Impact of Low-Dose Dronabinol Therapy on Cognitive Function in Cancer Patients Receiving Palliative Care: A Case-Series Intervention Study.

Background: Cannabis may offer therapeutic benefits to patients with advanced cancer not responding adequately to conventional palliative treatment. However, tolerability is a major concern. Cognitive function is a potential adverse reaction to tetrahydrocannabinol containing regimens. The aim of this study was to test cognitive function in patients being prescribed dronabinol as an adjuvant palliative therapy. Methods: Adult patients with advanced cancer and severe related pain refractory to conventional palliative treatment were included in this case-series study. Patients were examined at baseline in conjunction with initiation of dronabinol therapy and at a two-week follow-up using three selected Wechsler's adult intelligence scale III neurocognitive tests: Processing Speed Index (PSI), Perceptual Organization Index (POI), and Working Memory Index (WMI). Patients were also assessed using pain visual analog scale, Major Depression Inventory, and Brief Fatigue Inventory. Results: Eight patients consented to take part in the study. Two patients discontinued dronabinol therapy, one due to a complaint of dizziness and another critical progression of cancer disease, respectively. The remaining six patients were successfully treated with a daily dosage of 12.5 mg dronabinol (p = 0.039). PSI (p = 0.020), POI (p = 0.034.), and WMI (p = 0.039). Conclusions: Cognitive function improved in this group of patients with advanced cancer in conjunction with low-dose dronabinol therapy. The cause is likely multifactorial including reported relief of cancer-associated symptoms. Further clinical investigation is required.

Perception of Patients with Cancer Enquiring About Adjuvant Therapy with Cannabis Medicine for Palliation of Symptoms: An Interview Study among Danish Health Care Professionals.

Background: A medicinal cannabis pilot program was launched in Denmark in 2018 to support patients as countermeasure against self-medication by use of cannabis products from the illicit market. The aim was to facilitate patient access to adjuvate therapy using medicinal cannabis under the guidance of physicians. Objective: The aim of this interview study was to elucidate how health care professionals (HCPs) perceive cancer patients enquiring about cannabis medicine (CM), including medicinal cannabis and cannabis-based medicine, for adjuvant palliative therapy. Design: The program used semistructured qualitative research interviews with thematic analysis. Setting/Participants: Fifty HCPs took part in the study with 10 informants in each of the following 5 groups: oncologists, palliative care specialists, general practitioners, registered nurses in oncology, and in palliative care. Results: The informants reported that optional CM as adjuvant therapy was only discussed when initiated by the patient or relatives. Reluctance by HCPs to enter into a dialogue about CM with their patients was mainly explained by the lack of clinical evidence for the use of CM in palliative care of patients with cancer. None of the oncologists had ever prescribed CM, while three palliative care specialists and two general practitioners had issued prescriptions on rare occasions. Conclusion: HCPs involved in cancer treatment and palliative care are in general reluctant to discuss optional adjuvant CM therapy with their patients. The Danish health care authorities need to address this barrier to ensure that patients eligible for CM therapy are given this option as intended by the launch of the national pilot program.

Living with a Hope of Survival Is Challenged by a Lack of Clinical Evidence: An Interview Study among Cancer Patients Using Cannabis-Based Medicine.

Background: There is an increasing focus among cancer patients on the use of cannabis-based medicine (CBM) as a supplement to conventional palliative care. However, physicians are reluctant to engage in dialog with the patients as clinical evidence is lacking. As a result, the patients are often left alone to rely on their own judgment in purchasing CBM products on the illegal market. Objective: Our study aimed to collect information from CBM treatment-experienced cancer patients receiving palliative care regarding treatment decision rationale and outcome. Design: A qualitative interview study using thematic analysis was performed. Setting/Participants: A total of 20 informants took part in individual interviews. Results: To the question addressing the main rationale for starting CBM treatment, all 20 patients responded that they carried a hope that cannabis would have a curative effect on the cancer disease. Most patients reported relief of symptoms, such as insomnia, anxiety, nausea, and pain, after initiation of CBM treatment, but this outcome was perceived as less of a focus in comparison to hope of a cure. Conclusion: This study contributes with knowledge from the perspective of the cancer patient in palliative care regarding the decision behind the use of CBM. There seems to be striving for surviving cancer based on the rationale that cannabis may constitute curative properties. Relief of symptoms is perceived as a secondary reason for treatment. This knowledge is essential in the dialog between the health professional and the cancer patient about the use of CBM products for treatment.

How children handle life when their mother or father is seriously ill and dying.

AIMS AND OBJECTIVES: The aim of this study was to describe and understand how children handle their life when a mother or father is dying. METHODOLOGICAL DESIGN AND JUSTIFICATION: The research design was phenomenological hermeneutic. The phenomenological approach enabled us to capture the concrete everyday life of the children as it is understood and experienced by the children themselves. The hermeneutical approach offered the possibility of reaching an understanding of the children's experiences. RESEARCH METHODS: Seven children aged 11-17 years participated in the study. Data were collected using qualitative interviews and video diaries. ETHICAL CONSIDERATIONS: The researcher complied with ethical guidelines that apply to all researchers and followed ethical guidelines for nursing research in the Nordic Countries (Northern Nurses Federation). The children's names were changed, and the data were treated confidentially. FINDINGS: Analysis produced an overarching theme of death's waiting room, with following sub-themes: Relating to death, when death becomes even more clearly manifest and handling life in death's waiting room. STUDY LIMITATIONS: This study focuses on a limited explored area; children's lived life with a dying parent. The study limits itself to focusing on children's life world; by choosing this focus, we have not included the relational aspects that are essential aspects of children's lives. One might focus on these aspects in a second study to shed further light on the children's lives. CONCLUSION: When children live in a family with a dying mother or father, they find that their home is transformed from a safe base into death's waiting room. The children use a variety of ways to handle the confrontation with death. Avoiding talking to the children will not protect them from their thoughts about death.