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2.
J Pastoral Care Counsel ; 75(1_suppl): 17-23, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33730916

RESUMEN

This paper presents and discusses data from three of the qualitative questions in the international COVID-19 survey: What was the most important aspect of spiritual care that was lost during the pandemic? What was new to you during this pandemic? What are the new ways of delivering spiritual care you have experienced? Of these new experiences, what do you think was the most effective?


Asunto(s)
/psicología , Clero/psicología , Cuidado Pastoral/métodos , Cuidado Pastoral/normas , Humanos , Rol Profesional , Investigación Cualitativa , Encuestas y Cuestionarios , Cuidado Terminal/normas , Tacto
4.
Artículo en Inglés | MEDLINE | ID: mdl-33317794

RESUMEN

Malnutrition and the broad spectrum of cancer cachexia frequently occur in patients with malignant disease of all tumour stages and impact on survival and quality of life of patients. Structured screening for the risk of malnutrition with validated tools and nutritional assessment are the prerequisite for adequate nutritional support in cancer patients. In patients receiving tumour directed therapy, the patients diet should meet the requirements to give optimal support, while later on comfort feeding is part of symptom focused palliation. The basis of nutritional support in a malnourished patient is nutritional counselling, and nutritional support can be offered within a step-up approach meeting the patient's needs. A combination of nutritional support with interventions targeting metabolic changes and physical exercise is suggested to treat cancer cachexia.


Asunto(s)
Caquexia/terapia , Nutrición Enteral/métodos , Enfermedades Gastrointestinales/terapia , Estado Nutricional/fisiología , Apoyo Nutricional/métodos , Cuidados Paliativos/métodos , Calidad de Vida/psicología , Cuidado Terminal/normas , Anciano , Humanos
5.
Jpn J Clin Oncol ; 50(9): 976-989, 2020 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-32761078

RESUMEN

Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of 'filial piety,' patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient's end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient's poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of 'relational autonomy' and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.


Asunto(s)
Planificación Anticipada de Atención/normas , Cuidado Terminal/normas , Anciano , Envejecimiento , Grupo de Ascendencia Continental Asiática , Femenino , Humanos , Masculino
6.
BMJ Open ; 10(8): e037466, 2020 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-32759247

RESUMEN

OBJECTIVE: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN: Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING: Residential long-term care. PARTICIPANTS: 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS: Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION: Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.


Asunto(s)
Infecciones por Coronavirus/terapia , Cuidados a Largo Plazo , Cuidados Paliativos/normas , Pandemias , Médicos , Neumonía Viral/terapia , Instituciones de Cuidados Especializados de Enfermería , Cuidado Terminal/normas , Adulto , Anciano , Alberta , Actitud del Personal de Salud , Betacoronavirus , Infecciones por Coronavirus/virología , Familia , Femenino , Anciano Frágil , Fragilidad , Necesidades y Demandas de Servicios de Salud , Cuidados Paliativos al Final de la Vida , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/virología , Investigación Cualitativa , Respeto , Especialización
7.
Palliat Med ; 34(9): 1249-1255, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32736493

RESUMEN

BACKGROUND: The literature contains limited information on the problems faced by dying patients with COVID-19 and the effectiveness of interventions to manage these. AIM: The aim of this audit was to assess the utility of our end-of-life care plan, and specifically the effectiveness of our standardised end-of-life care treatment algorithms, in dying patients with COVID-19. DESIGN: The audit primarily involved data extraction from the end-of-life care plan, which includes four hourly nursing (ward nurses) assessments of specific problems: patients with problems were managed according to standardised treatment algorithms, and the intervention was deemed to be effective if the problem was not present at subsequent assessments. SETTING/PARTICIPANTS: This audit was undertaken at a general hospital in England, covered the 8 weeks from 16 March to 11 May 2020 and included all inpatients with COVID-19 who had an end-of-life care plan (and died). RESULTS: Sixty-one patients met the audit criteria: the commonest problem was shortness of breath (57.5%), which was generally controlled with conservative doses of morphine (10-20 mg/24 h via a syringe pump). Cough and audible respiratory secretions were relatively uncommon. The second most common problem was agitation/delirium (55.5%), which was generally controlled with standard pharmacological interventions. The cumulative number of patients with shortness of breath, agitation and audible respiratory secretions increased over the last 72 h of life, but most patients were symptom controlled at the point of death. CONCLUSION: Patients dying of COVID-19 experience similar end-of-life problems to other groups of patients. Moreover, they generally respond to standard interventions for these end-of-life problems.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Delirio/tratamiento farmacológico , Quimioterapia/normas , Disnea/tratamiento farmacológico , Cuidados Paliativos al Final de la Vida/normas , Cuidados Paliativos/normas , Neumonía Viral/mortalidad , Cuidado Terminal/normas , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/enfermería , Quimioterapia/estadística & datos numéricos , Femenino , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Cuidados Paliativos/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/enfermería , Guías de Práctica Clínica como Asunto , Cuidado Terminal/estadística & datos numéricos , Reino Unido/epidemiología
8.
An. pediatr. (2003. Ed. impr.) ; 93(1): 4-15, jul. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-199863

RESUMEN

INTRODUCCIÓN: La atención al final de la vida de los niños debe ser sensible a las necesidades del niño y de su familia. Necesitamos entender la enfermedad desde la perspectiva de los padres que se enfrentan a la muerte de su hijo, para poder mejorar la calidad y guiar el desarrollo de la atención al final de la vida en Pediatría. MÉTODO: Estudio observacional retrospectivo a través de cuestionario, para evaluar las necesidades, experiencias y satisfacción con la atención recibida, de una muestra de padres que perdieron un hijo por una causa previsible, entre junio de 2014 y junio de 2017. Diferenciamos tres grupos de estudio en función del equipo responsable de la atención al final de la vida, y las diferencias entre el grupo atendido por el equipo de cuidados paliativos pediátricos, el grupo atendido por pediatras no paliativistas y el grupo neonatal, son analizadas. RESULTADOS: De las 80 familias elegibles, 64 pudieron ser contactadas y 28 (43,8%) finalmente completaron el cuestionario. Nuestro estudio muestra experiencias positivas y alta satisfacción de los padres con la atención recibida al final de la vida de su hijo. Las puntuaciones más altas tanto en experiencias como en satisfacción, fueron otorgadas por los padres de los niños atendidos por el equipo de cuidados paliativos pediátricos con diferencias estadísticamente significativas en apoyo a la familia, comunicación, toma de decisiones compartida y atención en torno a la muerte (p < 0,05). CONCLUSIONES: Los padres están satisfechos con la atención recibida al final de la vida de sus hijos, pero la intervención de un equipo específico de cuidados paliativos pediátricos mejora la calidad de la atención al final de la vida en pediatría


INTRODUCTION: The care at the end of children's lives must be sensitive to the needs of the child and their family. An understanding of the illness is required from the perspective of parents faced with the death of their child, in order to improve quality and guide the development of end-of-life care in Paediatrics. METHOD: A retrospective observational study was conducted between June 2014 and June 2017 using a questionnaire, to assess the needs, experiences, and satisfaction with the care received, from a sample of parents who lost a child due to a foreseeable cause. Three different study groups were formed based on the team responsible for end-of-life care, and an analysis was carried out on the differences between the group treated by the paediatric palliative care team, the roup attended by non-palliative paediatricians, and the neonatal group. RESULTS: Of the 80 eligible families, 64 could be contacted, and 28 (43.8%) finally completed the questionnaire. Our study shows positive experiences and high satisfaction of parents with the care received at the end of their child's life. The highest scores in experiences and satisfaction were given by the parents of the children served by the paediatric palliative care team, with statistically significant differences in family support, communication, shared decision making, and bereavement support (P < .05). CONCLUSIONS: Parents are satisfied with the care received at the end of their children's lives, but the intervention of a specific paediatric palliative care team improves the quality of care at the end of life in paediatrics


Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Actitud Frente a la Salud , Cuidados Paliativos/normas , Padres/psicología , Grupo de Atención al Paciente/normas , Pediatría/normas , Relaciones Profesional-Familia , Cuidado Terminal/normas , Encuestas de Atención de la Salud , Evaluación de Necesidades , Cuidados Paliativos/métodos , Cuidados Paliativos/organización & administración , Cuidados Paliativos/psicología , Grupo de Atención al Paciente/organización & administración , Pediatría/métodos , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Estudios Retrospectivos , Cuidado Terminal/métodos , Cuidado Terminal/organización & administración , Cuidado Terminal/psicología
9.
Palliat Med ; 34(9): 1235-1240, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32588748

RESUMEN

BACKGROUND: Hospital clinicians have had to rapidly develop expertise in managing the clinical manifestations of COVID-19 including symptoms common at the end of life, such as breathlessness and agitation. There is limited evidence exploring whether end-of-life symptom control in this group requires new or adapted guidance. AIM: To review whether prescribing for symptom control in patients dying with COVID-19 adhered to existing local guidance or whether there was deviation which may represent a need for revised guidance or specialist support in particular patient groups. DESIGN/SETTING: A retrospective review of the electronic patient record of 61 hospital inpatients referred to the specialist palliative care team with swab-confirmed COVID-19 who subsequently died over a 1-month period. Intubated patients were excluded. RESULTS: In all, 83% (40/48) of patients were prescribed opioids at a starting dose consistent with existing local guidelines. In seven of eight patients where higher doses were prescribed, this was on specialist palliative care team advice. Mean total opioid dose required in the last 24 h of life was 14 mg morphine subcutaneous equivalent, and mean total midazolam dose was 9.5 mg. For three patients in whom non-invasive ventilation was in place higher doses were used. CONCLUSION: Prescription of end-of-life symptom control drugs for COVID-19 fell within the existing guidance when supported by specialist palliative care advice. While some patients may require increased doses, routine prescription of higher starting opioid and benzodiazepine doses beyond existing local guidance was not observed.


Asunto(s)
Biofarmacia/estadística & datos numéricos , Infecciones por Coronavirus/tratamiento farmacológico , Delirio/tratamiento farmacológico , Disnea/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Cuidado Terminal/métodos , Cuidado Terminal/normas , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/uso terapéutico , Betacoronavirus , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Midazolam/uso terapéutico , Persona de Mediana Edad , Morfina/uso terapéutico , Pandemias , Estudios Retrospectivos
10.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32584447

RESUMEN

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Neoplasias de Cabeza y Cuello/terapia , Control de Infecciones/normas , Oncología Médica/normas , Pandemias/prevención & control , Neumonía Viral/prevención & control , Atención Ambulatoria/normas , Terapia Combinada , Continuidad de la Atención al Paciente/normas , Infecciones por Coronavirus/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Sistemas Multiinstitucionales , Procedimientos Quirúrgicos Otorrinolaringológicos/normas , Cuidados Paliativos/normas , Seguridad del Paciente , Pennsylvania , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Cuidado Terminal/normas , Centros de Atención Terciaria
11.
PLoS One ; 15(6): e0235045, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32569329

RESUMEN

BACKGROUND: Oesophageal and gastric cancer are highly lethal malignancies with a 5-year survival rate of 15-29%. More knowledge is needed about the quality of end-of-life care in order to understand the burden of the illness and the ability of the current health care system to deliver timely and appropriate end-of-life care. The aim of this study was to describe the impact of initial treatment strategy and survival time on the quality of end-of-life care among patients with oesophageal and gastric cancer. METHODS: This register-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Esophageal and Gastric Cancer, the National Cause of Death Register, and the Swedish Register of Palliative Care, 2156 individuals were included. Associations between initial treatment strategy and survival time and end-of-life care quality indicators were investigated. Adjusted risk ratios (RRs) with 95% confidence intervals were calculated using modified Poisson regression. RESULTS: Patients with a survival of ≤3 months and 4-7 months had higher RRs for hospital death compared to patients with a survival ≥17 months. Patients with a survival of ≤3 months also had a lower RR for end-of-life information and bereavement support compared to patients with a survival ≥17 months, while the risks of pain assessment and oral assessment were not associated with survival time. Compared to patients with curative treatment, patients with no tumour-directed treatment had a lower RR for pain assessment. No significant differences were shown between the treatment groups regarding hospital death, end-of-life information, oral health assessment, and bereavement support. CONCLUSIONS: Short survival time is associated with several indicators of low quality end-of-life care among patients with oesophageal and gastric cancer, suggesting that a proactive palliative care approach is imperative to ensure quality end-of-life care.


Asunto(s)
Neoplasias Esofágicas/terapia , Calidad de Vida , Neoplasias Gástricas/terapia , Cuidado Terminal/normas , Anciano , Estudios de Cohortes , Femenino , Humanos , Masculino , Análisis de Supervivencia , Factores de Tiempo
12.
Rev Esp Salud Publica ; 942020 May 05.
Artículo en Español | MEDLINE | ID: mdl-32382000

RESUMEN

OBJECTIVE: Terminal patients and their relatives must know their real situation, and be treated according to the principle of autonomy, to establish therapeutic objectives adapted each one, according to their needs and decisions. The objective of this study is to identify the sufficient existence of records in the Medical Histories of terminal patients, which indicate their situation, such as the information given to the patients, or the LET, No-RCP or Z.51.5 codes, and the statistical relation they have with the sociodemographic and clinical variables. METHODS: Cross-sectional study in a third-level hospital, with patients admitted between January and December 2017, who died with terminal illness criteria. Data were collected from the medical records, and, fundamentally, from the nursing clinical notes. The statistical analysis was performed with the SPSS program, version 22. RESULTS: Participants were 140 people, 54.3% men, of 78.51 (SD=13.5) of middle age. People up to 70 years of age received less information (Odds ratio (OR): 0.077, 95% Confidence interval (CI): 0.015-0.390) and lower sedation (OR: 0.366, 95% CI: 0.149-0.899). Proceeding from city reduced the probability of receiving information (OR: 0.202; IC95%: 0.058-0.705). Presenting dyspnea reduced LTE (OR: 0.44, 95% CI: 0.20-093), No CPR (0.29, 95% CI: 0.12-0.68) and sedation (OR: 0.27; 95% CI: 0.12-060). Fatigue increased the probability of being Non-CPR (OR: 2.77, 95% CI: 1.166-6.627) and of receiving sedation (OR: 2.6, 95% CI: 1.065-6.331). CONCLUSIONS: Efforts to empower the patient in the decision of their process and the management of the information of their diagnosis and prognosis are still lacking. A greater and better clinical records facilitates knowing how actions are developed, allowing to identify and implement ethical and responsible interventions.


Asunto(s)
Directivas Anticipadas/ética , Registros Médicos , Participación del Paciente , Autonomía Personal , Mejoramiento de la Calidad/ética , Cuidado Terminal/ética , Centros de Atención Terciaria/ética , Adulto , Directivas Anticipadas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Toma de Decisiones/ética , Femenino , Hospitalización , Humanos , Consentimiento Informado/ética , Consentimiento Informado/normas , Consentimiento Informado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Participación del Paciente/métodos , Participación del Paciente/estadística & datos numéricos , Mejoramiento de la Calidad/estadística & datos numéricos , Estudios Retrospectivos , España , Cuidado Terminal/normas , Cuidado Terminal/estadística & datos numéricos , Centros de Atención Terciaria/normas , Centros de Atención Terciaria/estadística & datos numéricos
13.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32394338

RESUMEN

Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.


Asunto(s)
Infecciones por Coronavirus/terapia , Cuidados Críticos/organización & administración , Neumonía Viral/terapia , Cuidado Terminal/organización & administración , Anestesiólogos/organización & administración , Anestesiólogos/normas , Competencia Clínica , Infecciones por Coronavirus/mortalidad , Cuidados Críticos/normas , Humanos , Cuidados Paliativos/organización & administración , Pandemias , Médicos/organización & administración , Médicos/normas , Neumonía Viral/mortalidad , Cuidado Terminal/normas , Privación de Tratamiento
14.
Epilepsia ; 61(7): 1336-1340, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32463125

RESUMEN

Vagus nerve stimulation (VNS) is often used for patients with drug-resistant epilepsy. Although this intervention may improve seizure control and mood, a number of factors must be considered when patients with VNS near end of life. We reviewed relevant literature to create a proposed guideline for management of patients with VNS in palliative care and after death. VNS has multiple possible side effects, including cough and swallowing difficulties. For patients with neurologic disease in palliative care, such adverse effects can severely affect quality of life and increase the risk for complications such as aspiration pneumonia. Patients with VNS should be screened regularly for such side effects, and VNS parameters should be adjusted if they are identified. If a patient requires urgent cardiac resuscitation involving external defibrillation, the VNS should be interrogated immediately afterwards to evaluate its function. During defibrillation, paddles should be placed perpendicular to the VNS, and as far as possible away from it. The VNS can be acutely turned off by taping the magnet to the patient's chest, thereby preventing any possible interference with restoration of a normal heart rhythm. After death, any staff involved with handling the body should be notified that a VNS is in place. The device must be removed prior to cremation, as it can explode with high heat. If the cause of death is unclear, a full postmortem examination should be undertaken, per sudden unexpected death in epilepsy guidelines. If there is concern about device malfunction, the device should be returned to the manufacturer for evaluation.


Asunto(s)
Epilepsia Refractaria/terapia , Neuroestimuladores Implantables/normas , Cuidados Paliativos/normas , Guías de Práctica Clínica como Asunto/normas , Cuidado Terminal/normas , Estimulación del Nervio Vago/normas , Muerte Encefálica/diagnóstico , Humanos , Cuidados Paliativos/métodos , Cuidado Terminal/métodos , Estimulación del Nervio Vago/instrumentación
16.
Med Clin North Am ; 104(3): 391-403, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312405

RESUMEN

Prognostication is a vital aspect of decision making because it provides patients and families with information to establish realistic and achievable goals of care, is used in determining eligibility for certain benefits, and helps in targeting interventions to those likely to benefit. Prognostication consists of 3 components: clinicians use their clinical judgment or other tools to estimate the probability of an individual developing a particular outcome over a specific period of time; this prognostic estimate is communicated in accordance with the patient's information preferences; the prognostic estimate is interpreted by the patient or surrogate and used in clinical decision making.


Asunto(s)
Competencia Clínica/normas , Enfermedad Crítica/terapia , Planificación de Atención al Paciente/normas , Atención Dirigida al Paciente/métodos , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas/ética , Comunicación , Enfermedad Crítica/epidemiología , Demencia/mortalidad , Demencia/terapia , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Humanos , Esperanza de Vida/tendencias , Masculino , Neoplasias/mortalidad , Neoplasias/terapia , Cuidados Paliativos/normas , Percepción , Pronóstico , Cuidado Terminal/normas
17.
Public Health Res Pract ; 30(1)2020 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-32152613

RESUMEN

Recent reports highlight an inconsistent provision of palliative and end-of-life (palliative) care across Australia, particularly in regional, rural and remote areas. Palliative care improves quality of life and the experience of dying, and all people should have equitable access to quality needs-based care as they approach and reach the end of their lives. A palliative approach to care is crucial in rural and remote Australia where there is a reliance for such care on generalist providers amid the challenges of a limited workforce, poorer access, and vast geography. This article describes the development and implementation of the Far West NSW Palliative and End-of-Life Model of Care, a systematic solution that could drive improvement in the provision of a quality palliative approach to care and support from any clinician in a timely manner, for patients, their families and carers anywhere.


Asunto(s)
Cuidados Paliativos/normas , Servicios de Salud Rural/estadística & datos numéricos , Cuidado Terminal/normas , Australia , Necesidades y Demandas de Servicios de Salud , Humanos , Calidad de la Atención de Salud , Calidad de Vida , Población Rural
18.
BMC Palliat Care ; 19(1): 31, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32164672

RESUMEN

BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient's profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. METHODS: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011-2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). RESULTS: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16-0.72], ranging between 0.53 [0.20-0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07-0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. CONCLUSIONS: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.


Asunto(s)
Toma de Decisiones Conjunta , Servicio de Oncología en Hospital/normas , Derivación y Consulta/normas , Factores de Tiempo , Anciano , Prestación Integrada de Atención de Salud/métodos , Prestación Integrada de Atención de Salud/normas , Prestación Integrada de Atención de Salud/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/clasificación , Neoplasias/terapia , Servicio de Oncología en Hospital/organización & administración , Servicio de Oncología en Hospital/tendencias , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/tendencias , Derivación y Consulta/tendencias , Estudios Retrospectivos , Cuidado Terminal/organización & administración , Cuidado Terminal/normas , Cuidado Terminal/tendencias
19.
G Ital Cardiol (Rome) ; 21(4): 286-295, 2020 Apr.
Artículo en Italiano | MEDLINE | ID: mdl-32202561

RESUMEN

Treatment of patients with heart failure is based on drugs, cardiac surgery and implantable cardiac devices to prevent sudden cardiac death (implantable cardioverter-defibrillator [ICD]), to reverse left ventricular dysfunction associated with left bundle branch block (cardiac resynchronization therapy) or mechanical circulatory support in more advanced phases of heart failure (left ventricular assist devices [LVAD]).During the follow-up, patients may die from progression of their underlying heart disease or from non-arrhythmic causes, such as malignancies, multi-organ failure, stroke, etc., without benefits by implanted devices. Patients implanted with ICD could die from non-arrhythmic causes, without appropriate shocks until the last few days or weeks of their life. These events occur roughly in 30% of patients, mainly in the last 24 h before death. LVAD therapy may induce significant complications, such as infections, hemorrhagic stroke, thromboembolism, right ventricular failure. In these cases, inappropriate and even appropriate shock deliveries by ICD can no longer prolong life and may simply lead to pain and reduced quality of life, as well as LVAD may prolong life with painful distress due to complications. Therefore, it appears important to discuss early with the patients and their relatives about deactivation of ICD or LVAD at the end of life. The goal of this paper is to provide an overview of the ethical, clinical and communication issues of cardiac implanted device deactivation, with a special focus on issues associated with advance care planning, which require shared decision-making, including those related to end of life decisions (advance directives). Palliative care should be early implemented, particularly in patients with LVAD.


Asunto(s)
Desfibriladores Implantables , Insuficiencia Cardíaca , Cuidado Terminal/normas , Directivas Anticipadas , Arritmias Cardíacas , Terapia de Resincronización Cardíaca , Muerte Súbita Cardíaca , Toma de Decisiones , Desfibriladores Implantables/ética , Insuficiencia Cardíaca/terapia , Corazón Auxiliar , Humanos , Calidad de Vida , Cuidado Terminal/ética , Disfunción Ventricular Izquierda
20.
Am J Occup Ther ; 74(1): 7401205020p1-7401205020p14, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32078513

RESUMEN

IMPORTANCE: Underutilization of hospice occupational therapy may be attributable to a lack of evidence on efficacy. OBJECTIVE: To conduct a scoping review of occupational therapy outcome studies to ascertain how efficacy is captured in the literature. DATA SOURCES: PubMed, CINAHL, MEDLINE, Scopus, Directory of Open Access Journals, Web of Science, OT Search, and Google Scholar. STUDY SELECTION AND DATA COLLECTION: Search terms: hospice, palliative care, occupational therapy, rehabilitation, outcome measure, and assessment. Inclusion criteria: research studies in English, centered on adult hospice care, published between January 1997 and September 2017, and investigated occupational therapy efficacy with an outcome measure. Exclusion criteria: systematic reviews, participants not at terminal disease end stages, or intervention program reviews lacking differentiated occupational therapy outcomes. FINDINGS: Seven articles met the inclusion criteria. Findings include frequent use of noncontrolled, quasi-experimental, prospective research designs; a focus on occupational performance; and no generally accepted hospice occupational therapy outcome measure. CONCLUSION AND RELEVANCE: Outcome measures of participation in end-of-life occupations and environmental influences on occupational engagement are needed to effectively support occupational therapy practice and research with people who are terminally ill. WHAT THIS ARTICLE ADDS: Occupational therapy in end-of-life care is growing in complexity yet remains low in utilization. This review adds insights into current practice and future research foci for the profession.


Asunto(s)
Cuidados Paliativos al Final de la Vida , Terapia Ocupacional , Cuidado Terminal , Adulto , Humanos , Cuidados Paliativos , Estudios Prospectivos , Cuidado Terminal/normas
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