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1.
Artículo en Alemán | MEDLINE | ID: mdl-31968387

RESUMEN

Patients with palliative diseases often suffer from a variety of onerous symptoms with marked impairment in quality of life. The treatment is often difficult. One reason is that patients usually have several problems at the same time. Another reason is that the need for medication can cause additional side effects, which in turn have to be treated as well. In this article we explain most of these symptoms and give treatment recommendations based on the current literature (excluding pain therapy). In particular, this article is divided into the following sub-items: mucositis/stomatitis, dyspnea, nausea, constipation, anxiety, depression, weakness/fatigue, delirium, sleep disorders and terminal restlessness, pruritus, pleural effusion, ascites. Most palliative patients need individualized treatment. Sometimes medication has to be used in an off-label way, and sometimes one must just hold a hand and be there for the patient or their relatives. The most important principle in working with palliative care patients is to maintain or restore quality of life. Our therapy should always be adapted to the needs of the patient and the most important goal is to preserve our patients' autonomy.


Asunto(s)
Neoplasias , Cuidados Paliativos , Cuidado Terminal , Ansiedad , Depresión , Disnea , Humanos , Náusea , Neoplasias/terapia , Calidad de Vida
2.
Artículo en Alemán | MEDLINE | ID: mdl-31968388

RESUMEN

One third of oncological treatment costs per patient is allocated to the last phase of life. In the era of molecular oncology and immuno-oncology, patients benefit from new treatment options inducing durable and long-lasting responses. However, it becomes more difficult to estimate the prognosis of oncology patients. The treatment indication is based on the evidence from randomized controlled studies. In contrast, the decision, when to stop treatment at the end of life and provide best supportive care, is an emerging and challenging situation in routine clinical care of oncologists and palliative care teams. Up to 50% of oncology patients receive chemotherapy within the last 4 weeks before death, thus it becomes evident to stop futile treatment. Reliable biomarkers to predict the response of immunotherapy are lacking for most of solid tumors. Several palliative prognostic scores have been validated to calculate the probability of survival in the next 30 - 60 days. Unfortunately, there is no consensus on which score should be preferred and none was validated in period of immuno-oncology. The estimation of expectation of life by an interdisciplinary medical team is recommended by the German guideline of palliative medicine. Of note, treating physicians often overestimate the prognosis of patients, and shared decision making whether to start, to continue or to stop therapy for the individual patient remains difficult. Early integration of palliative medicine and advance care planning focus on the patient's medical perspective. Clinical trials investigating the integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Changes at the system level are necessary for implementation of advance care planning to improve the quality of the end of life of oncology patients.


Asunto(s)
Neoplasias , Cuidados Paliativos , Calidad de Vida , Cuidado Terminal , Humanos , Oncología Médica , Neoplasias/terapia
3.
Artículo en Alemán | MEDLINE | ID: mdl-31968389

RESUMEN

Palliative care is becoming increasingly important in intensive care units. The main goal of palliative treatment is to improve quality of life in patients with critical and life-threatening conditions when curative therapies can no longer be achieved. Treatment is not limited to end-of-life care, but also includes relief of distressing symptoms such as pain, nausea, vomiting, dyspnea, delirium or anxiety, as well as communication with patients and their families. Defining patient-centred goals of care together with patients, relatives and intensive care staff supports shared decision-making. Aspects of palliative care can be integrated in the ICU in different ways. The "integrative model" presumes that all patients with critical illness may benefit from palliative care principles and interventions practiced by the ICU team. The "consultative model" involves palliative care consultants in the care of ICU patients with palliative care need that may be identified using trigger criteria. This article gives an overview on different aspects of palliative care in intensive care units and provides practical advice for the implementation of palliative care in the ICU.


Asunto(s)
Unidades de Cuidados Intensivos , Cuidados Paliativos , Cuidado Terminal , Cuidados Críticos , Humanos , Calidad de Vida
4.
J Nurs Adm ; 50(2): 72-77, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31929345

RESUMEN

OBJECTIVE: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence. BACKGROUND: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals. METHODS: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the association between Magnet hospitals and measures of end-of-life care quality. RESULTS: Overall, nurses report poor quality of end-of-life care in US hospitals. In Magnet hospitals, nurses were significantly less likely to give their hospital an unfavorable rating on end-of-life care. CONCLUSIONS: Hospital Magnet status may signal better quality in end-of-life care. Administrators looking to improve the quality of end-of-life care may consider improving aspects of nursing that distinguish Magnet hospitals.


Asunto(s)
Hospitales/estadística & datos numéricos , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Cuidado Terminal/psicología , Cuidado Terminal/normas , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Cultura Organizacional , Cuidado Terminal/estadística & datos numéricos , Estados Unidos
7.
Gesundheitswesen ; 82(1): 50-58, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31863445

RESUMEN

BACKGROUND: Dementia is usually a life-limiting disease. However, evidence-based guidelines for palliative care for people with dementia (PwD) are currently lacking. One reason for this is the dearth of reliable empirical data on PwD at the end of life. The aim of this study is to describe the symptom burden, causes of death, places of death and the use of various health services for PwD at the end of life. METHODS: The Bavarian Dementia Survey (BayDem) was a multi-center, longitudinal study at 3 different sites in Bavaria, Germany (Dachau, Kronach, Erlangen). Participants were PwD defined by ICD-10 and their informal caregivers. Data were collected in standardized face-to-face interviews in cooperation with local actors. In order to obtain comparable groups, deceased and non-deceased PwD were matched using 1:1 propensity score matching. For the statistical analyses, McNemar tests as well as paired t-tests were used. RESULTS: In this analysis, 58 deceased and 58 non-deceased PwD were studied (n=116). In most cases, PwD died at home (36.2%), in hospital (25.9%) or in a nursing home (19.0%), but no one in palliative care. The most common causes of death were respiratory (13.8%) and cardiovascular complications (12.1%) as well as stroke (12.1%). PwD at the end of life showed more pronounced physical comorbidities than the other PwD (Charlson-Index: M=2.75 vs. M=1.80; p=0.030, Cohen's d=0.425) and were therefore admitted to hospital (46.6 vs. 12.1%, p<0.001, OR=6.250) or emergency departments (22.4 vs. 3.4%, p=0.007, OR=6.500) more frequently. Behavioral and psychological symptoms were very pronounced (NPI Score: M=31.67 vs. M=24.77, p=0.118, Cohen's d=0.303). Nevertheless, the utilization of outpatient health services was low. CONCLUSION: The results underline the need to develop evidence-based guidelines to provide palliative care specifically adapted to the needs of PwD at the end of life. In this context, the high incidence of behavioral and psychological symptoms should be taken into account, as should the high incidence of physical comorbidities. Considering the frequent hospital admissions, special attention should also be paid to the development of recommendations for the inpatient sector (acute hospital and palliative care unit).


Asunto(s)
Causas de Muerte , Demencia , Utilización de Instalaciones y Servicios , Cuidado Terminal , Cuidadores , Costo de Enfermedad , Demencia/mortalidad , Demencia/terapia , Alemania/epidemiología , Humanos , Estudios Longitudinales , Calidad de Vida , Encuestas y Cuestionarios
8.
Int J Radiat Oncol Biol Phys ; 106(1): 52-60, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31682969

RESUMEN

PURPOSE: This prospective study aimed to determine the accuracy of radiation oncologists in predicting the survival of patients with metastatic disease receiving radiation therapy and to understand factors associated with their accuracy. METHODS AND MATERIALS: This single-institution study surveyed 22 attending radiation oncologists to estimate patient survival. Survival predictions were defined as accurate if the observed survival (OS) was within the correct survival prediction category (0-6 months, >6-12 months, >12-24 months, and >24 months). The physicians made survival estimates for each course of radiation, yielding 877 analyzable predictions for 689 unique patients. Data analysis included Stuart's Tau C, logistic regression models, ordinal logistic regression models, and stepwise selection to examine variable interactions. RESULTS: Of the 877 radiation oncologists' predictions, 39.7% were accurate, 26.5% were underestimations, and 33.9% were overestimations. Stuart's Tau C showed low correlation between OS and survival estimates (0.3499), consistent with the inaccuracy reported in the literature. However, results showed less systematic overprediction than reported in the literature. Karnofsky performance status was the most significant predictor of accuracy, with greater accuracy for patients with shorter OS. Estimates were also more accurate for patients with lower Karnofsky performance status. Accuracy by patient age varied by primary site and race. Physician years of experience did not correlate with accuracy. CONCLUSIONS: The sampled radiation oncologists have a 40% accuracy in predicting patient survival. Future investigation should explore how survival estimates influence treatment decisions and how to improve survival prediction accuracy.


Asunto(s)
Esperanza de Vida , Neoplasias/mortalidad , Oncólogos de Radiación , Anciano , Competencia Clínica , Exactitud de los Datos , Femenino , Predicción , Humanos , Estado de Ejecución de Karnofsky/estadística & datos numéricos , Modelos Logísticos , Masculino , Metástasis de la Neoplasia , Neoplasias/patología , Neoplasias/radioterapia , Estudios Prospectivos , Oncólogos de Radiación/estadística & datos numéricos , Análisis de Supervivencia , Cuidado Terminal , Factores de Tiempo
9.
Einstein (Sao Paulo) ; 18: eRW4852, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31618287

RESUMEN

The objective of this study was to identify the variables that influence physicians to implement Advance Directives and assess their impact on end-of-life care. It is a narrative literature review of 25 articles published between 1997 and 2018, in the following databases: CAPES, EBSCOhost, BDTD, VHL, Google Scholar, MEDLINE®/PubMed. The keywords utilized were: "advance directives", "living wills", "physicians", "attitude", "decision making", "advance care planning". The main factors that influenced physicians to implemente the directives were patients prognosis, medical paternalism, and patients understanding of their medical condition. Respect for autonomy, lack of knowledge and experience with directives, legal concerns, family influence, cultural and religious factors also contributed to medical decision. Most studies (86%) showed that having a directive led to lower rates of invasive interventions in the last days of patient´s life. Physicians were interested in respecting their patients' autonomy and agreed that having an advance directive helped in the decision-making process; however, they stated other factors were also taken into account, mainly prognosis and reversibility conditions. Having directives contributed to reducing the use of life support therapies and adoption of comfort measures.


Asunto(s)
Adhesión a las Directivas Anticipadas/psicología , Médicos/psicología , Cuidado Terminal , Directivas Anticipadas , Actitud del Personal de Salud , Toma de Decisiones , Humanos , Paternalismo , Autonomía Personal
10.
Nurs Educ Perspect ; 41(1): 52-53, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31860490

RESUMEN

This article summarizes a pilot simulation using standardized patients that was designed to develop skills necessary to care for the critically ill mental health patient nearing the end of life. Although the simulation was found to be a valuable teaching strategy, additional research, with a rigorous design, is recommended to further develop this teaching method. The authors suggest adopting a theoretical framework for debriefing that would elicit emotions, address the emotional needs of students, and assist them to develop coping strategies and skills necessary to care for patients at the end of life.


Asunto(s)
Enfermedad Crítica , Trastornos Mentales , Cuidado Terminal , Competencia Clínica , Emociones , Humanos , Salud Mental , Simulación de Paciente , Cuidado Terminal/normas
11.
Medicine (Baltimore) ; 98(49): e18082, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804317

RESUMEN

OBJECTIVES: Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups. METHODS: Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal- and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year. RESULTS: Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age. CONCLUSIONS: Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.


Asunto(s)
Gastos en Salud/estadística & datos numéricos , Neoplasias Pancreáticas/economía , Neoplasias Pancreáticas/terapia , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Modelos Lineales , Masculino , Medicare/estadística & datos numéricos , Modelos Econométricos , Estadificación de Neoplasias , Programa de VERF , Cuidado Terminal/economía , Estados Unidos
12.
Rev Med Chil ; 147(6): 727-732, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859825

RESUMEN

BACKGROUND: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. MATERIALS AND METHODS: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi2 test were used to assess a time series and regional analysis, respectively. RESULTS: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001,27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). CONCLUSIONS: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Mortalidad/tendencias , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Chile/epidemiología , Estudios Transversales , Certificado de Defunción , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Probabilidad , Política Pública , Análisis Espacio-Temporal , Cuidado Terminal , Factores de Tiempo
13.
Rev Infirm ; 68(255): 34-36, 2019 Nov.
Artículo en Francés | MEDLINE | ID: mdl-31757328

RESUMEN

In the context of the care of people at the end of life, the implementation of measures relating to advance healthcare directives still appears to be problematic. A nursing team in Saône-et-Loire carried out a research project on this issue and highlighted several obstacles: poor knowledge of the law, a lack of information among the general public, the sensitivity of the subject, etc. The project revealed avenues for further reflection now being explored.


Asunto(s)
Directivas Anticipadas , Cuidado Terminal , Humanos
14.
J Law Med ; 27(1): 178-191, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31682349

RESUMEN

Terminal sedation is a medically induced coma from which the patient does not recover. Professional guidelines for palliative care restrict its use to within a few days of death. The law relating to its use in Australia is governed by the law of homicide, assisted suicide and the law of trespass. In this article, I argue that the law in Australia does not justify the restrictions on its use imposed by the professional guidelines, and that, ethically and legally, it can be made available to patients with a terminal disease, those who are likely to suffer serious physical or existential pain by remaining conscious, and for those who refuse food and water. Its use should be regulated to ensure that those asking for it are competent to do so, and that they are suffering from a medical condition that makes life intolerable for them.


Asunto(s)
Sedación Profunda , Eutanasia , Suicidio Asistido , Cuidado Terminal , Australia , Humanos , Cuidados Paliativos
16.
Z Gerontol Geriatr ; 52(8): 743-750, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31696363

RESUMEN

Although the nursing home setting has some characteristic features that are relevant with respect to the development of moral distress (MD), it has so far been studied primarily in the acute care setting. The underlying classical definition of MD is increasingly criticized and broadening of this definition is encouraged to include stress due to moral uncertainty. Hence, the present qualitative study explored how nursing personnel in nursing homes experience MD. Guided interviews were conducted with 21 nurses from 5 nursing homes. The fully transcribed interviews were analyzed using Mayring's qualitative content analysis, whereby deductive (scaling and content structuring) and inductive techniques were applied. The application of scaling structuring revealed that MD was experienced mainly in a moderately severe form. The respondents reported situations where they experienced moral stress because they were impeded by barrieres to take the morally correct action. These situations were inductively summarized in the categories "unnecessary/false treatment at the end of life", "incorrect management of challenging behavior", "poor care in general" and "unnecessary hospital transfers". Decisions made by relatives and physicians were the most frequently mentioned external barrier and a lack of courage was the most frequently named internal barrier; however, the respondents also mentioned stress reactions corresponding to the category "moral uncertainty", especially during end of life care and for hospital transfer decisions, most of all when the resident's wish was not clear or due to unavailability of physicians. The results underline the necessity of a broad conception of MD at the theoretical and interventional levels.


Asunto(s)
Principios Morales , Personal de Enfermería , Estrés Psicológico , Cuidado Terminal , Humanos , Investigación Cualitativa
17.
Medicine (Baltimore) ; 98(44): e17809, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31689865

RESUMEN

INTRODUCTION: Almost all patients with end-of-life cancer experience cancer-related fatigue; however, there are only a few known effective coping methods. OBJECTIVES: We will conduct a prospective, multi-center, single-blinded randomized controlled study to evaluate the efficacy of acupuncture for cancer-related fatigue in patients with end-of-life cancer. METHODS: We will enroll 120 patients with cancer hospitalized in a palliative care unit or receiving consultation from a palliative care team in four hospitals. We will add acupuncture treatment; specifically, contact needle therapy (CNT), consisting of an intervention per week period to the usual care. The primary outcome measure will be the Cancer Fatigue Scale (CFS) score while the secondary outcome measures will be the Numerical Rating Scale (NRS) score for fatigue, pain, and salivary amylase levels. CONCLUSION: We will evaluate the possibility of using acupuncture therapy, that is, CNT, in relieving fatigue sensation in patients with advanced cancer. TRIAL REGISTRATION: UMIN000028304, registered on July 21st, 2017; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000032401.


Asunto(s)
Terapia por Acupuntura/métodos , Fatiga/terapia , Neoplasias/complicaciones , Neoplasias/terapia , Cuidados Paliativos , Adulto , Fatiga/etiología , Humanos , Medicina Kampo , Estudios Prospectivos , Método Simple Ciego , Cuidado Terminal
18.
Presse Med ; 48(11 Pt 1): e293-e306, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31734050

RESUMEN

BACKGROUND: Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS: This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS: Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS: In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.


Asunto(s)
Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Atención Domiciliaria de Salud , Neoplasias/mortalidad , Neoplasias/terapia , Cuidado Terminal , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , Comorbilidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Francia , Medicina General/estadística & datos numéricos , Atención Domiciliaria de Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Servicios de Enfermería/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Estudios Retrospectivos , Distribución por Sexo , Factores de Tiempo , Transporte de Pacientes/estadística & datos numéricos
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