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2.
J Clin Nurs ; 29(1-2): 139-151, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31535417

RESUMEN

AIMS AND OBJECTIVES: To explore palliative care nurses' work experiences caring for patients at the end of life in private homes. BACKGROUND: The home continues to be a desired place for care and dying; however, professional competence is needed and specialist palliative care nurses play a crucial role, often highly valued by patients and their family members. The private home as a physical work environment for nurses is explored, with both positive and negative aspects being described. To ensure future high-quality end-of-life care, there is a need to describe how palliative care nurses work in private homes. DESIGN: Interpretative descriptive. METHODS: Participant-generated photographs were used in conjunction with follow-up interviews with ten palliative home care nurses. Interpretive description was used for analysis. This study follows the COREQ checklist. RESULTS: The analysis process resulted in four constructed themes, presented here as strategies used by palliative care nurses: adjusting interactions and actions depending on the environment when entering each unique private home; supporting patients and family members in finding a balance between self-care, independence and safe care; guiding patients and family members towards and through environmental changes supporting end-of-life care at home; and using transitions between homes to reflect, recuperate and prepare. CONCLUSION: Working as a palliative care nurse in private homes clearly requires a variety of skills and competences, here operationalised in different strategies used to promote high-quality care. RELEVANCE TO CLINICAL PRACTICE: Palliative care nurses' considerations, insights and competence when performing end-of-life care in the diverse environments of private homes can contribute to the development of clinical practice. Knowledge about strategies can be used in nursing practice during everyday work, in nursing education and in the organisation of care, and can inform policy to ensure future high-quality palliative home care.


Asunto(s)
Enfermería de Cuidados Paliativos al Final de la Vida/organización & administración , Cuidados Paliativos/métodos , Fotograbar , Cuidado Terminal/métodos , Adulto , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Masculino , Relaciones Enfermero-Paciente , Investigación Cualitativa
3.
Medicina (B Aires) ; 79(6): 468-476, 2019.
Artículo en Español | MEDLINE | ID: mdl-31829949

RESUMEN

The integrated care pathways for the last days of life propose quality standards optimizing the care of patients and families. The Pallium Multidisciplinary Assistance Program (PAMPA ©) was implemented based on standards of the International Collaborative for Best Care for the Dying Person in 4 phases: induction, implementation, dissemination and sustainability, in five health centres in Argentina, between 2008 and 2018. A total of 1237 adult patients in the last days of life were included and cared for by palliative care teams trained in PAMPA©. An audit was conducted before and after the implementation of the Program, which is still going on. The median range of follow up into five centres from the beginning of the pathway until death varied from 16 to 178 hours. Care goals were compared: symptom control, communication, multidimensional needs, hydration and nutrition, documentation of interventions and post-mortem care. The overall analysis showed an improvement in the number of records (p = 0.001). The goal of communication on care plan to the patient showed no difference (p = 0.173). Continuous training, support and permanent teams supervision were carried out and perceptions and impact of the implementation were registered. The main emerging items of the qualitative analysis were: attitudes towards the program, fundamental contributions, strengths, weaknesses and subjective definition of the program, recognition of institutional cultural singularities and its influence on care. PAMPA© demonstrated its feasibility as a model of end of life care for patients and families, based on international quality standards.


Asunto(s)
Cuidados Paliativos/normas , Evaluación de Programas y Proyectos de Salud , Garantía de la Calidad de Atención de Salud/normas , Cuidado Terminal/normas , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Vías Clínicas/normas , Femenino , Implementación de Plan de Salud/métodos , Implementación de Plan de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Reproducibilidad de los Resultados , Cuidado Terminal/métodos , Factores de Tiempo
4.
Transplant Proc ; 51(9): 2899-2901, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31606182

RESUMEN

At times, clinical expertise may not be sufficient to find a way out of a moral impasse, especially in the context of end-of-life and organ transplantation decisions. Advances in medical knowledge and technology, and highly pluralistic and multicultural societies, have led to the emergence of new ethical problems in daily clinical practice along with the need to manage them in a prompt and effective manner. Clinical ethics developed in the late 1970s and early 1980s in North American health care contexts with the aim of identifying, analyzing, and attempting to resolve ethical conflicts and dilemmas at the patient's bedside. At present, only a few regions in Italy have established clinical ethics committees, and Italy may count on a very small number of clinical ethics services fully devoted to ethics case consultation, guidelines development, and the education of health care providers and citizens. Despite this situation, one has to acknowledge both the increasing request for ethics support coming from health care providers who experience an "ethical vacuum" in the Italian health care system and the cultural change that is affecting Italy nowadays. By highlighting clinical examples and sharing experiences, we show and encourage the potential benefits of establishing clinical ethics services in Italian health care contexts.


Asunto(s)
Comités de Ética Clínica , Ética Clínica , Trasplante de Órganos/ética , Cuidado Terminal/ética , Humanos , Italia , Cuidado Terminal/métodos
5.
Transplant Proc ; 51(9): 3018-3026, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31627922

RESUMEN

BACKGROUND: Intensive care to facilitate organ donation (ICOD) has been defined as the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom treatment for curative purposes is deemed futile, and who are considered possible organ donors, with the aim of offering donation after brain death (DBD) inside their end-of-life care plans. We describe the effect on the donation and transplantation activity of the implementation of ICOD protocol at a university hospital. METHODS: Retrospective analysis (2015-2018) of demographics and outcomes of all patients with a DBI, in whom ICOD was considered as part of their end-of-life care in Vall d'Hebron University Hospital, Barcelona. RESULTS: Of the 983 possible donors evaluated, ICOD was considered in 206 (21%), of whom 115 (55.8%) were medically unsuitable for donation. Family consent was obtained for 69 (76%) of the remaining patients. Refusal rate was twice as high when nontherapeutic ventilation was required for organ donation (34%) vs patients previously ventilated (13.6%) (P = .02). Patients subject to ICOD died in a median of 2 days (1-3 d) and 88.4% became actual donors (39 after brain death; 22 after circulatory death). Nine (17.6%) donors were finally not utilized. ICOD contributed to 29% (ranging from 27.7% in 2015 to 31.6% in 2018) of the 208 actual donors and 26% of the 603 organs transplanted. CONCLUSIONS: ICOD is well-accepted by families and offers the donation option to an increasing number of patients at our hospital. It provides an important and sustained increment of the organ pool for transplantation.


Asunto(s)
Cuidados Críticos/métodos , Cuidado Terminal/métodos , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Humanos , Unidades de Cuidados Intensivos , Masculino , Trasplante de Órganos/métodos , Derivación y Consulta , Estudios Retrospectivos , España , Cuidado Terminal/psicología
6.
BMC Health Serv Res ; 19(1): 698, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615500

RESUMEN

BACKGROUND: Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life. METHODS: A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012-2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF. RESULTS: We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21-1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death. CONCLUSIONS: We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.


Asunto(s)
Atención de Enfermería/estadística & datos numéricos , Cuidado Terminal/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Continuidad de la Atención al Paciente/estadística & datos numéricos , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Atención Domiciliaria de Salud/métodos , Atención Domiciliaria de Salud/estadística & datos numéricos , Cuidados Paliativos al Final de la Vida/métodos , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Vida Independiente , Lactante , Recién Nacido , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Noruega , Atención de Enfermería/métodos , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Sistema de Registros , Proyectos de Investigación , Estudios Retrospectivos , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Cuidado Terminal/métodos , Adulto Joven
7.
Br J Nurs ; 28(16): 1069-1075, 2019 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-31518543

RESUMEN

Recent years have seen a recognition of the importance of talking openly to patients at the end of life about death and dying. This article aims to add to the existing body of literature on this subject. Conversations at the end of life can be difficult, particularly if the patient is experiencing mental distress alongside their terminal illness. A number of factors can disrupt a constructive and supportive conversation around death and dying. This article offers a frame of reference for nurses to consider when having such conversations.


Asunto(s)
Comunicación , Muerte , Relaciones Enfermero-Paciente , Cuidado Terminal/métodos , Humanos
8.
Neurology ; 93(17): 729-734, 2019 10 22.
Artículo en Inglés | MEDLINE | ID: mdl-31530709

RESUMEN

In legal physician-hastened death, a physician prescribes medication with the primary intent of causing the death of a willing terminally ill patient. This practice differs radically from palliative sedation, intended to relieve a patient's suffering rather than cause a patient's death. In this position paper, we argue that the practice of physician-hastened death is contrary to the interests of patients, their families, and the sound ethical practice of medicine. Therefore, the American Academy of Neurology should advise its members against this practice, as it had done until 2018.


Asunto(s)
Cuidados Paliativos , Cuidado Terminal , Humanos , Países Bajos , Neurología/ética , Neurología/métodos , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Sociedades Médicas , Cuidado Terminal/ética , Cuidado Terminal/métodos , Estados Unidos
9.
Geriatr Gerontol Int ; 19(9): 847-853, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31389113

RESUMEN

AIM: The purpose of the present study was to collate examples of end-of-life care guidelines from various counties, examine their contents, and gain an overall picture of how end-of-life care guidance is offered to physicians and care providers internationally. METHODS: In this study, eight researchers worked independently to source and examine national-level end-of-life care guidelines from different countries and regions. Data collected by each researcher were gathered into a unified table. The items in the table included basic information (publisher, year, URL etc.) and more specific items, such as the presence/absence of legal information and family's role in decision-making. These data were then used to identify trends, and examine the mechanics and delivery of guidance on this topic. RESULTS: A total of 54 guidelines were included in the study. All the guidelines were published between 2000 and 2016, and 60% (n = 33) were published after 2012. The length of the guidelines varied from two to 487 pages (median 38 pages), and had different target audiences - both lay and professional. A total of 38 (70%) of the guidelines included information about the relevant laws and legal issues, 47 (87%) offered advice on withholding and withdrawing treatment, 46 (85%) discussed the family's role in decision-making and 46 (85%) emphasized the teamwork aspect of care. CONCLUSIONS: The present findings show that end-of-life care guidelines are generally made reactively in response to the trend toward patient-centered care, and that to create effective guidelines and implement them requires multilevel cooperation between governmental bodies, healthcare teams, and patients and their families. Geriatr Gerontol Int 2019; 19: 847-853.


Asunto(s)
Toma de Decisiones Clínicas , Guías de Práctica Clínica como Asunto , Cuidado Terminal , Privación de Tratamiento , Actitud del Personal de Salud , Toma de Decisiones Clínicas/ética , Toma de Decisiones Clínicas/métodos , Fluidoterapia/métodos , Salud Global , Humanos , Apoyo Nutricional/métodos , Relaciones Profesional-Familia , Cuidado Terminal/ética , Cuidado Terminal/métodos , Cuidado Terminal/organización & administración , Cuidado Terminal/tendencias , Privación de Tratamiento/ética , Privación de Tratamiento/legislación & jurisprudencia
10.
Recenti Prog Med ; 110(7): 343-346, 2019.
Artículo en Italiano | MEDLINE | ID: mdl-31379369

RESUMEN

The distinction between physiological and dysfunctional emotions in end-of-life care may be hard, for a twofold reason: on the one hand, the patient as a subject, with specific clinical features, personality, system of values; on the other hand, the clinical judgment by involved health professionals, particularly their specific cut-offs in discrimination between normal suffering and psychopathology. Both excessive/untimely medicalization and underestimation of medical conditions such as anxiety, depression, suicidal ideation, and insomnia may be a risk while dealing with end-of-life patients. Prompt, reliable psychiatric diagnosing contributes significantly to the major goal of dignity in death. The aims of a psychiatric consultation for patients with end-stage diseases should be: controlling concomitant psychiatric symptoms, managing pain and physical symptoms, assisting patient and relatives in the crisis-management, mediating conflicts between patient, family and ward personnel, and planning advocacy.


Asunto(s)
Derivación y Consulta , Cuidado Terminal/métodos , Enfermo Terminal/psicología , Depresión/diagnóstico , Depresión/terapia , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia
11.
BMC Palliat Care ; 18(1): 65, 2019 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-31375118

RESUMEN

BACKGROUND: Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. METHODS: A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). RESULTS: Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. CONCLUSION: Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. TRIAL REGISTRATION: The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193 ).


Asunto(s)
Terapia con Arte/instrumentación , Cuidado Terminal/métodos , Escritura , Terapia con Arte/métodos , Terapia con Arte/normas , Humanos , Cuidado Terminal/psicología
12.
Prim Care ; 46(3): 461-473, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31375193

RESUMEN

Pediatric palliative care and hospice medicine is a field in which a multidisciplinary team assists in the management and treatment of infants, children, and young adults with a serious condition. A therapeutic relationship is created among the team, patients, and their caregivers to address total pain. This encompasses exploration of physical pain, social, spiritual, and emotional pain. Patient-centered and family-centered shared decision-making is paramount when setting and revisiting goals of care with patients and their families. Consider a checklist when faced with a dying patient so that the family and team feel supported.


Asunto(s)
Familia/psicología , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Factores de Edad , Anorexia/terapia , Niño , Preescolar , Toma de Decisiones , Delirio/terapia , Emociones , Pesar , Humanos , Lactante , Recién Nacido , Relaciones Interpersonales , Manejo del Dolor/métodos , Planificación de Atención al Paciente , Calidad de Vida , Espiritualidad , Cuidado Terminal/métodos , Cuidado Terminal/psicología
13.
BMC Palliat Care ; 18(1): 71, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409329

RESUMEN

BACKGROUND: Caring for someone with dementia can be physically and emotionally difficult. Acting as a caregiver can make it difficult to access sources of support, particularly in the later stages of dementia. This paper reports the development and presents the targets (subject areas) and components of a prototype website to support family caregivers of a person with dementia towards the end of life. METHODS: Adopting an iterative approach and co-production methods the development process consisted of four stages: Stage1-Synthesis of data: three sources of data (interviews, systematic review and theory) were synthesised using tabulation, to identify the targets of the prototype; Stage2-Identifying intervention targets and components: a research development group (health practitioners, a family caregiver and academic experts) met to discuss the development, using a modified nominal group process, refining the synthesis from stage 1; Stage3-Developing the intervention prototype: an outline of the prototype was developed based on stage 1 and 2; and Stage4-User testing: interviews with caregivers testing the prototype website. RESULTS: Qualitative interviews with caregivers identified four targets for the intervention: 1) feeling prepared and equipped; 2) feeling connected and supported; 3) valuing themselves as a caregiver and as an individual; 4) maintaining control of the caring situation and being the coordinator of care. The systematic review provided evidence on how and what components could address these targets, including providing information, peer support, contact with professionals, and psychological support. Theory helped to narrow the focus within each of these targets. Active discussion with the research development group and end users provided an outline of the prototype website. The prototype website presented addresses these targets with written information, videos from other caregivers, and peer and professional support sections. The subject areas covered included expectations at the end of life, support with day-to-day caring, care planning, and communication. CONCLUSIONS: This paper provides a detailed account of the development process of a prototype website for caregiver support. The transparent methodology and key lessons learnt from developing the prototype should help those who are developing similar interventions, across complex, progressive conditions and not just limited to dementia.


Asunto(s)
Demencia/psicología , Familia/psicología , Medios de Comunicación Sociales/normas , Apoyo Social , Anciano , Anciano de 80 o más Años , Demencia/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida/psicología , Cuidado Terminal/métodos , Cuidado Terminal/psicología
14.
Surg Clin North Am ; 99(5): 1019-1027, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31446907

RESUMEN

Shared decision making requires the exchange of information from the patient and the surgeon (and ideally involves the expertise of the entire multidisciplinary team) to determine the medical and/or surgical treatment that best aligns with the patient's goals and values. Should the surgical patient wish to transition to end-of-life care, the transition to comfort-focused care is within the scope of practice for surgeons. Incorporating the expertise of other health care professionals is an important consideration for whole-patient care. Integrating primary palliative care into surgical practice can help mitigate unnecessary suffering and allow a smoother transition to comfort-focused care.


Asunto(s)
Cuidados Paliativos , Cuidado Terminal , Directivas Anticipadas , Toma de Decisiones , Corazón Auxiliar , Humanos , Obstrucción Intestinal/terapia , Cuidado Terminal/métodos
15.
BMC Res Notes ; 12(1): 521, 2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31426854

RESUMEN

OBJECTIVE: The aim of this study was to assess nurses' Knowledge, Attitude and Associated Factors towards end of life care in Amhara Referral Hospitals, Northwest Ethiopia, 2017. RESULTS: A total of 331 participants were included with a response rate of 93.2%. From these, 129 (39.0%) of them had good knowledge and 234 (70.7%) had favorable attitude towards end of life care. Being Bachelor of Science holder and above in nursing (AOR = 4.261, 95% CI 1.524-11.912), working in Emergency department (AOR = 4.911, 95% CI 1.796-13.426), having daily experience of caring for chronically ill patients (AOR = 2.764, 95% CI 1.366-5.591) and taking training on end of life care (AOR = 10.269, 95% CI 4.730-22.296) were significantly associated with good knowledge of nurses towards end of life care. On the other hand, having 6-10 years of working experience in nursing (AOR = 2.199, 95% CI 1.147-4.215), being trained in end of life care (AOR = 3.027, 95% CI 1.285-7.13), Bachelor of Science holder and above in nursing (AOR = 4.414, 95% CI 2.230-8.738) were found to be statistically significant with more positive attitude of nurses towards end of life care.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Enfermeras y Enfermeros/estadística & datos numéricos , Derivación y Consulta , Encuestas y Cuestionarios , Cuidado Terminal/métodos , Adulto , Estudios Transversales , Etiopía , Femenino , Humanos , Masculino , Análisis Multivariante , Rol de la Enfermera/psicología , Cuidado Terminal/psicología , Adulto Joven
16.
Home Healthc Now ; 37(4): 208-212, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274583

RESUMEN

In 2010, the Institute of Medicine published the vision for how to transform healthcare to achieve a more seamless patient-centered, high-quality system of care. Among the recommendations were four specifically focused on leveraging nursing which is the largest group of healthcare workers: (1) Ensure that nurses can practice to the full extent of their education and training, (2) Improve nursing education, (3) Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts, and (4) Improve data collection for workforce planning and policy making. At the Care New England Health Care System's Visiting Nurse Association, located in the state of Rhode Island, we redesigned access to end-of-life care by leveraging these recommendations. An experienced palliative care nurse practitioner (NP) leads the program development to improve care delivered by home healthcare nurses and NP specialists. This program was designed to allow patients to remain in their preferred setting of care-their home-until the end of their life. In the 5 years of this program's existence, it has achieved a yearly impact on community-based palliative care and hospice services. The number of documented advance directives increased by 75%, referrals to palliative care and hospice increased by 300% and the length of time on hospice doubled. In addition, NP home visits became an accepted referral source and improvements in both the quality and satisfaction scores for the home healthcare agency were realized.


Asunto(s)
Accesibilidad a los Servicios de Salud , Enfermería de Cuidados Paliativos al Final de la Vida , Guías de Práctica Clínica como Asunto , Cuidado Terminal , Accesibilidad a los Servicios de Salud/organización & administración , Cuidados Paliativos al Final de la Vida/métodos , Cuidados Paliativos al Final de la Vida/organización & administración , Enfermería de Cuidados Paliativos al Final de la Vida/métodos , Enfermería de Cuidados Paliativos al Final de la Vida/organización & administración , Enfermería de Cuidados Paliativos al Final de la Vida/normas , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Rhode Island , Cuidado Terminal/métodos , Cuidado Terminal/organización & administración , Cuidado Terminal/normas , Cuidado Terminal/estadística & datos numéricos
17.
Recenti Prog Med ; 110(6): 269-270, 2019 06.
Artículo en Italiano | MEDLINE | ID: mdl-31282481

RESUMEN

In the opening lecture of the congress of the American Society of Clinical Oncology (ASCO), the famous US surgeon Atul Gawande addressed the issue of the role of the doctor, focusing on the care of patients with terminal illnesses. Prolonging life should not represent the goal of the doctor's decision-making, who must instead pay attention to preserving the patient's quality of life as much as possible. The relationship between doctor and patient must be based on some fundamental questions that the clinician must address to the patient in order to know his goals. The lecture was one of the key moments of the ASCO congress, very attentive to issues concerning the sustainability of care and the experiences of patients. It is surprising, however, that such a patient-centered conference was not disseminated and commented on by patient advocates on social media as it deserved.


Asunto(s)
Relaciones Médico-Paciente , Calidad de Vida , Cuidado Terminal/métodos , Toma de Decisiones , Humanos , Rol del Médico , Médicos/organización & administración
18.
BMC Palliat Care ; 18(1): 62, 2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31345196

RESUMEN

BACKGROUND: End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. METHODS: The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals (n = 14) from the wards. The analysis followed Spradley's ethnosemantic analysis. RESULTS: The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a "here-and-now" status of the patient's disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient's and relatives' thoughts and wishes concerning EOL, which allowed long-term care planning. CONCLUSION: This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.


Asunto(s)
Relaciones Profesional-Paciente , Cuidado Terminal/psicología , Adulto , Anciano , Dinamarca , Femenino , Grupos Focales/métodos , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Cuidado Terminal/métodos
19.
Oncology ; 97(4): 217-227, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31220846

RESUMEN

OBJECTIVE: Little data about the management of drugs in terminally ill palliative care cancer patients is available. The present study aimed at describing the evolution of anticancer and non-anticancer treatments (NACTs) in cancer patients in palliative care units. The second objective was to identify factors leading to the medical decision to withdraw or not NACTs. METHODS: Data from 1,091 cancer patients hospitalized in palliative care units were prospectively collected in 2010-2011, through a multicenter, observational French cohort. RESULTS: The median overall survival after admittance in palliative care units was 15 days. Specific anticancer treatments were systematically stopped in the first 24 h in palliative care units, but for 4.5% of patients. Regarding NACTs, patients were heavily treated with strong opioids (74%), corticosteroids (51%), and antidepressants (21.8%) until death. Antiulcer agents (63.4%), antibiotics (25.7%), thrombosis prevention (21.8%), antidiabetics (7.6%), and transfusions (4%) were often also continuously prescribed. In multivariate analysis, ECOG PS 4 was an independent predictor of continuous prescription of morphine and an independent predictor of discontinuation of corticosteroids, proton-pump inhibitors, antidiabetics, and preventive anticoagulant therapy. Infection symptoms independently predicted continuous prescription of paracetamol. Paralysis and cancer palpable mass independently predicted corticosteroid withdrawal. Brain metastases independently predicted antiulcer withdrawal. Hemorrhage independently predicted preventive anticoagulant withdrawal. Availability to a venous access independently predicted paracetamol and antiulcer continuous prescriptions. Co-prescriptions independently predicted continuous prescriptions (antibiotics with antiulcer, antifungals with antibiotics) or withdrawal (preventive anticoagulant with antiplatelets and antifungals). CONCLUSIONS: NACT prescription remained commonplace in terminally ill palliative cancer patients, although their benefit is questionable.


Asunto(s)
Neoplasias/tratamiento farmacológico , Cuidados Paliativos/métodos , Cuidado Terminal/métodos , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Femenino , Francia , Hospitalización , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Neoplasias/patología , Estudios Prospectivos , Enfermo Terminal , Adulto Joven
20.
BMC Palliat Care ; 18(1): 51, 2019 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-31238934

RESUMEN

BACKGROUND: Few studies have specifically assessed the scope, nature and challenges of palliative and end-of-life care in rural general practice. These knowledge gaps limit the development of evidence-based policies and services for patients in the last months of life. This study aimed to explore the perspectives of general practitioners (GPs) and other stakeholders on rural GPs' involvement and challenges in providing palliative and end-of-life care in regional Australia. METHODS: A qualitative study involving five focus groups with 26 GPs based in rural/regional Western Australia together with 15 individual telephone interviews with four GPs and 11 other stakeholders involved in end-of-life care across Australia. RESULTS: The rural GPs' central role in end-of-life care was recognized by the majority of participants but multiple challenges were also identified. Some challenges were comparable to those found in urban settings but others were more pronounced, including resource limitations and lack of training. Inappropriate payment models discouraged GPs' involvement in some aspects of end-of-life care, such as case conferences and home visits. Compared to GPs in urban settings, those in rural/regional communities often reported closer doctor-patient relationships and better care integration and collaboration. These positive aspects of care could be further developed to enhance service provision. Our study highlighted the importance of regular interactions with other professionals and patients in providing end-of-life care, but many GPs and other stakeholders found such interactions more challenging than the more "technical" aspects of care. CONCLUSIONS: Rural/regional GPs appear to be disproportionately affected by inappropriate payment models and limited resources, but may benefit from closer doctor-patient relationships and better care integration and collaboration relative to urban GPs. Systematic collection of empirical data on GP management at end-of-life is required to build on these strengths and address the challenges.


Asunto(s)
Medicina General/tendencias , Médicos Generales/psicología , Población Rural , Cuidado Terminal/métodos , Adulto , Actitud del Personal de Salud , Femenino , Grupos Focales/métodos , Médicos Generales/tendencias , Visita Domiciliaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Investigación Cualitativa , Cuidado Terminal/tendencias , Australia Occidental
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