Comprehension and Decision-Making Capacity Questionnaire About Palliative Care and Advance Care Planning: A Delphi Study.

Objective(s): To develop a questionnaire that assesses the level of comprehension and decision-making capacity of patients with breast cancer about palliative care and advance care planning. Methods: Questionnaire items were based on the scientific literature. Delphi Consensus, a three-round survey with experts (n = 14), evaluated the relevance, clarity, and redundancies of the items. A pretest with breast cancer patients (n = 15) evaluated whether they comprehended each item and identified doubts or discomforts. Results: The initial questionnaire was composed of 38 items. After the Delphi, 18 items were restructured, six were added, and 16 were removed. In the pretest phase, all items with the survey header, guidelines, and Likert model were evaluated. All items accomplished ≥80% cut-off score and were kept as in the original version. The final version of the questionnaire have 28 itens and five domains: determination, responsibility, independence, self-knowledge, and knowledge of reality. Conclusions: This study represents the first step in the development of a questionnaire that may be used in oncology clinical practice. The main findings revealed that Delphi and pretesting increased the quality of the questionnaire, making it compelling to assess breast cancer patients' comprehension and decision-making capacity about PC and ACP.

The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities.

OBJECTIVE: To assess the frequency and factors associated of the provision of nutrition support (NS) in the last 30 days of life in patients with advanced cancer in the palliative or non-palliative setting. METHODS: Retrospective cohort study in palliative and non-palliative care units at a specialized cancer center for oncology in Brazil. The use of oral nutrition supplements (ONS) and enteral (EN) and parenteral (PN) nutrition in the 30 days before death were assessed. RESULTS: The 239 patients included were predominantly older (>60 years; 63.2%) and female (61.1%). The use of ONS was lower in palliative than non-palliative care during the last 30 (52% vs. 6%), 7 (42% vs. 4%), and 3 (23% vs. 2%) days before death (all P < .001). The use of EN and PN was lower in palliative care, decreasing with the approach of death. The independent factors associated with ONS in non-palliative care were (odds ratio): breast tumor (3.03), hypoalbuminemia (1.10), and nutrition risk (16.98); in palliative care, only the Karnofsky Performance Status (KPS) ≥40% (1.24) was associated to the use of ONS. The use of EN and PN was associated with head-neck (HN) tumor in both settings (5.41) in non-palliative and (8.74) in palliative. Others independent factors were: hypoalbuminemia (3.12) in non-palliative care and KPS (1.31) in palliative care. CONCLUSIONS: The use of NS near the end of life was high in the non-palliative and less frequent in palliative care setting. The factors associated with NS differed according to the clinical oncology setting, with one of the factors in palliative care being a better prognosis.

Prognostic factors in patients with advanced cancer and COVID-19: a cohort from the Palliative Care Unit of the Brazilian National Cancer Institute.

OBJECTIVE: To describe overall survival (OS) in 90 days and to evaluate the prognostic factors in patients with advanced cancer and COVID-19. METHODS: This is a retrospective cohort study carried out at the Palliative Care Unit of the Brazilian National Cancer Institute. Patients with advanced cancer and COVID-19 confirmed by Reverse Transcription Polymerase Chain Reaction were included. Kaplan-Meier's curves, log-rank test, and Cox regression were performed. RESULTS: Eighty-three inpatients were selected. The average age was 61.4 (±12.6) years, with a higher proportion of women (73.4%). The most prevalent tumor type was breast (36.7%), followed by gastrointestinal tract (20.3%). The OS was 32 [interquartile range (IQR): 6-70] days, and at the end of the follow-up period, 17 patients (20.5%) were alive and 66 (79.5%) had died. Patients with advanced cancer and COVID-19 and who were 60-74 years old [hazard ratio (HR): 2.03; 95% confidence interval (CI): 1.09-3.78], with lung tumors (HR: 17.50; 95% CI: 1.70-28.34), with lung metastasis (HR: 4.21; 95% CI: 2.17-8.15), and with chronic obstructive pulmonary disease (HR: 4.92; 95% CI: 1.01-24.69) had higher risk of death in 90 days. CONCLUSION: The age of 60-74 years old, lung tumors (primary or metastases), and the presence of chronic obstructive pulmonary disease were considered independent prognostic factors in patients with advanced cancer and COVID-19.