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1.
Med Clin North Am ; 104(3): 525-538, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312413

RESUMEN

Medical emergencies at the end of life require recognition of patients at risk, so that a comprehensive assessment and plan of care can be put in place. Frequently, the interventions depend on the patient's underlying prognosis, location of care, and goals of care. The mere presence of a medical emergency often rapidly changes an estimated prognosis. Education of the patient and family may help empower them to adequately handle many situations when clinicians are not available.


Asunto(s)
Urgencias Médicas/epidemiología , Cuidados Paliativos al Final de la Vida/normas , Planificación de Atención al Paciente/normas , Cuidado Terminal/métodos , Anciano , Anciano de 80 o más Años , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/uso terapéutico , Diagnóstico Diferencial , Hemorragia/etiología , Hemorragia/terapia , Humanos , Hipercalcemia/etiología , Persona de Mediana Edad , Neoplasias/complicaciones , Cuidados Paliativos/normas , Cuidados Paliativos/estadística & datos numéricos , Planificación de Atención al Paciente/tendencias , Pronóstico , Factores de Riesgo , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/terapia , Estado Epiléptico/tratamiento farmacológico , Estado Epiléptico/etiología , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/terapia
2.
Med Clin North Am ; 104(3): 561-572, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32312415

RESUMEN

Burnout is common in physicians who care for patients with serious illness, with rates greater than 60% in some studies. Risk factors for burnout include working on small teams and/or in small organizations, working longer hours and weekends, being younger than 50 years, burdensome documentation requirements, and regulatory issues. Personal factors that can protect against burnout include mindfulness, exercise, healthy sleep patterns, avoiding substance abuse, and having adequate leisure time. Institutional and work factors that can buffer against burnout include working on adequately staffed teams, having a manageable workload, and minimally burdensome electronic health record documentation.


Asunto(s)
Agotamiento Profesional/prevención & control , Agotamiento Profesional/psicología , Médicos/psicología , Adulto , Agotamiento Profesional/economía , Agotamiento Profesional/epidemiología , Depresión/etiología , Empatía/fisiología , Ejercicio Físico/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Plena/métodos , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Calidad de Vida , Factores de Riesgo , Autocuidado/métodos , Sueño/fisiología , Trastornos Relacionados con Sustancias/etiología , Suicidio/psicología , Suicidio/estadística & datos numéricos , Estados Unidos/epidemiología , Carga de Trabajo
3.
Bull Cancer ; 107(3): 308-321, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32035648

RESUMEN

INTRODUCTION: Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study. METHODS: People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death. RESULTS: A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual. DISCUSSION: This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.


Asunto(s)
Gastos en Salud , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/terapia , Anciano , Anciano de 80 o más Años , Causas de Muerte , Comorbilidad , Cuidados Críticos/economía , Cuidados Críticos/estadística & datos numéricos , Quimioterapia/economía , Quimioterapia/estadística & datos numéricos , Femenino , Francia/epidemiología , Mortalidad Hospitalaria , Humanos , Cobertura del Seguro/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Cuidados Paliativos/estadística & datos numéricos , Características de la Residencia , Cuidado Terminal/estadística & datos numéricos , Factores de Tiempo
4.
PLoS One ; 15(1): e0226597, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32005036

RESUMEN

PURPOSE: To evaluate whether the early identification of patients who may benefit from palliative care impacts on the use of palliative, community and acute-based care services. METHODS: Between 2014 and 2017, physicians from eight sites were encouraged to systematically identify patients who were likely to die within one year and would were thought to benefit from early palliative care. Patients in the INTEGRATE Intervention Group were 1:1 matched to controls selected from provincial healthcare administrative data using propensity score-matching. The use of palliative care, community-based care services (home care, physician home visit, and outpatient opioid use) and acute care (emergency department, hospitalization) was each evaluated within one year after the date of identification. The hazard ratio (HR) in the Intervention Group was calculated for each outcome. RESULTS: Of the 1,185 patients in the Intervention Group, 951 (80.3%) used palliative care services during follow-up, compared to 739 (62.4%) among 1,185 patients in the Control Group [HR of 1.69 (95% CI 1.56 to 1.82)]. The Intervention Group also had higher proportions of patients who used home care [81.4% vs. 55.2%; HR 2.07 (95% CI 1.89 to 2.27)], had physician home visits [35.5% vs. 23.7%; HR 1.63 (95% CI 1.46 to 1.92)] or had increased outpatient opioid use [64.3% vs. 52.1%); HR 1.43 (95% CI 1.30 to 1.57]. The Intervention Group was also more likely to have a hospitalization that was not primarily focused on palliative care (1.42 (95% CI 1.28 to 1.58)) and an unplanned emergency department visit for non-palliative care purpose (1.47 (95% CI 1.32 to 1.64)). CONCLUSION: Physicians actively identifying patients who would benefit from palliative care resulted in increased use of palliative and community-based care services, but also increased use of acute care services.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Prestación Integrada de Atención de Salud , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Tasa de Supervivencia
5.
J Surg Res ; 246: 269-273, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31614324

RESUMEN

BACKGROUND: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. MATERIALS AND METHODS: We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams. RESULTS: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001). CONCLUSIONS: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.


Asunto(s)
Toma de Decisiones , Familia , Planificación de Atención al Paciente , Cuidado Terminal/organización & administración , Heridas y Traumatismos/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/organización & administración , Cuidados Paliativos/estadística & datos numéricos , Transferencia de Pacientes/organización & administración , Transferencia de Pacientes/estadística & datos numéricos , Estudios Retrospectivos , Factores de Tiempo , Centros Traumatológicos/organización & administración , Centros Traumatológicos/estadística & datos numéricos , Índices de Gravedad del Trauma , Heridas y Traumatismos/diagnóstico , Heridas y Traumatismos/mortalidad
6.
J Surg Res ; 246: 224-230, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31606512

RESUMEN

BACKGROUND: Older patients with traumatic brain injury (TBI) have higher mortality and morbidity than their younger counterparts. Palliative care (PC) is recommended for all patients with a serious or life-limiting illness. However, its adoption for trauma patients has been variable across the nation. The goal of this study was to assess PC utilization and intensity of care in older patients with severe TBI. We hypothesized that PC is underutilized despite its positive effects. MATERIALS AND METHODS: The National Inpatient Sample database (2009-2013) was queried for patients aged ≥55 y with International Classification of Diseases, Ninth Revision codes for TBI with loss of consciousness ≥24 h. Outcome measures included PC rate, in-hospital mortality, discharge disposition, length of stay (LOS), and intensity of care represented by craniotomy and or craniectomy, ventilator use, tracheostomy, and percutaneous endoscopic gastrostomy. RESULTS: Of 5733 patients, 78% died in hospital with a median LOS of 1 d, and 85% of the survivors were discharged to facilities. The overall PC rate was 35%. Almost 40% of deaths received PC, with nearly half within 48 h of admission. PC was used in 26% who had neurosurgical procedures, compared with 35% who were nonoperatively managed (P = 0.003). PC was associated with less intensity of care in the entire population. For survivors, those with PC had significantly shorter LOS, compared with those without PC. CONCLUSIONS: Despite high mortality, only one-third of older patients with severe TBI received PC. PC was associated with decreased use of life support and lower intensity of care. Significant efforts need to be made to bridge this quality gap and improve PC in this high-risk population.


Asunto(s)
Atención de Apoyo Vital Avanzado en Trauma/estadística & datos numéricos , Lesiones Traumáticas del Encéfalo/terapia , Cuidados Paliativos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Atención de Apoyo Vital Avanzado en Trauma/organización & administración , Atención de Apoyo Vital Avanzado en Trauma/tendencias , Factores de Edad , Anciano , Anciano de 80 o más Años , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/mortalidad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Mortalidad Hospitalaria , Humanos , Puntaje de Gravedad del Traumatismo , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/normas , Cuidados Paliativos/tendencias , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/tendencias , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/estadística & datos numéricos , Mejoramiento de la Calidad/tendencias , Estudios Retrospectivos , Centros Traumatológicos/organización & administración , Centros Traumatológicos/tendencias , Estados Unidos
7.
Hosp Pract (1995) ; 48(1): 23-28, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31847615

RESUMEN

Objectives: The Pulmonary Embolism Response Team (PERT) model is now widely adopted in many institutions to provide multidisciplinary care for patients with acute pulmonary embolism (PE). However, descriptive experiences of PERT operations and studies on clinical outcomes remain limited.Methods: We performed a retrospective review of PERT activations at an academic tertiary care center, with secondary aims to study outcomes associated with performing catheter directed therapies (CDT).Results: The intermediate high-risk PE category was most frequent (n = 40, 76.9%) among the 52 total cases evaluated during the study period. There was one in-hospital mortality, associated with hospice admission for a non-PE diagnosis. Six patients (11.5%) experienced a bleeding complication of any severity. Anticoagulation (AC) alone was recommended in 30 patients (57.7%) and CDT was performed in 16 patients (30.8%). There were no significant differences in patient characteristics or disease severity between patients in the AC group versus the CDT group, except for a higher prevalence of malignancy in the AC group (p = 0.037). Patients who underwent CDT demonstrated a lower, albeit non-significant, median intensive care unit (ICU) length of stay (LOS) (3 vs. 4 days, p = 0.34) and hospital LOS (4 vs. 5 days, p = 0.25), as compared to patients receiving AC alone. Bleeding rates were similar between the two groups (6.7% vs. 6.3%, p = 1.0).Conclusions: Adoption of the PERT model at an academic tertiary care center was associated with acceptably low rates of mortality and bleeding, similar to other published studies. Performing CDT in select patients under PERT consultation may be associated with shorter ICU and hospital LOS; however, larger studies are needed to validate this finding.


Asunto(s)
Anticoagulantes/uso terapéutico , Ablación por Catéter/métodos , Grupo de Atención al Paciente/organización & administración , Embolia Pulmonar/cirugía , Terapia Trombolítica/métodos , Enfermedad Aguda , Adulto , Anciano , Anticoagulantes/administración & dosificación , Ablación por Catéter/efectos adversos , Femenino , Hemorragia/etiología , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Cuidados Paliativos/estadística & datos numéricos , Embolia Pulmonar/tratamiento farmacológico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Centros de Atención Terciaria , Terapia Trombolítica/efectos adversos
8.
Support Care Cancer ; 28(1): 303-308, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31044306

RESUMEN

PURPOSE: To analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers. METHOD: This was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016-2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child's life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed. RESULT: Twenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons). CONCLUSION: Home-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.


Asunto(s)
Actitud Frente a la Muerte , Servicios de Salud del Niño , Emociones , Neoplasias , Padres/psicología , Cuidado Terminal/psicología , Adolescente , Adulto , Conducta , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Niño , Preescolar , Femenino , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Cuidados Paliativos al Final de la Vida/psicología , Cuidados Paliativos al Final de la Vida/estadística & datos numéricos , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Neoplasias/psicología , Neoplasias/terapia , Cuidados Paliativos/psicología , Cuidados Paliativos/estadística & datos numéricos , Relaciones Padres-Hijo , Aceptación de la Atención de Salud/psicología , Encuestas y Cuestionarios , Cuidado Terminal/estadística & datos numéricos
9.
Support Care Cancer ; 28(1): 295-301, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31044305

RESUMEN

BACKGROUND: An international panel achieved consensus on 9 need-based and 2 time-based major referral criteria to identify patients appropriate for outpatient palliative care referral. To better understand the operational characteristics of these criteria, we examined the proportion and timing of patients who met these referral criteria at our Supportive Care Clinic. METHODS: We retrieved data on consecutive patients with advanced cancer who were referred to our Supportive Care Clinic between January 1, 2016, and February 18, 2016. We examined the proportion of patients who met each major criteria and its timing. RESULTS: Among 200 patients (mean age 60, 53% female), the median overall survival from outpatient palliative care referral was 14 (95% confidence interval 9.2, 17.5) months. A majority (n = 170, 85%) of patients met at least 1 major criteria; specifically, 28%, 30%, 20%, and 8% met 1, 2, 3, and ≥ 4 criteria, respectively. The most commonly met need-based criteria were severe physical symptoms (n = 140, 70%), emotional symptoms (n = 36, 18%), decision-making needs (n = 26, 13%), and brain/leptomeningeal metastases (n = 25, 13%). For time-based criteria, 54 (27%) were referred within 3 months of diagnosis of advanced cancer and 63 (32%) after progression from ≥ 2 lines of palliative systemic therapy. The median duration from patient first meeting any criterion to palliative care referral was 2.4 (interquartile range 0.1, 8.6) months. CONCLUSIONS: Patients were referred early to our palliative care clinic and a vast majority (85%) of them met at least one major criteria. Standardized referral based on these criteria may facilitate even earlier referral.


Asunto(s)
Atención Ambulatoria/organización & administración , Neoplasias/terapia , Cuidados Paliativos/organización & administración , Selección de Paciente , Derivación y Consulta/organización & administración , Adulto , Anciano , Atención Ambulatoria/métodos , Atención Ambulatoria/estadística & datos numéricos , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Preescolar , Consenso , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/patología , Evaluación de Procesos y Resultados en Atención de Salud , Pacientes Ambulatorios , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos
10.
Arch Gerontol Geriatr ; 86: 103955, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31561064

RESUMEN

BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.


Asunto(s)
Planificación Anticipada de Atención/tendencias , Directivas Anticipadas/estadística & datos numéricos , Demencia/terapia , Casas de Salud/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Cuidado Terminal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Muerte , Demencia/mortalidad , Demencia/psicología , Femenino , Finlandia/epidemiología , Hogares para Ancianos/estadística & datos numéricos , Hospitalización , Humanos , Masculino , Prevalencia , Estudios Retrospectivos
11.
Am J Hosp Palliat Care ; 37(1): 58-64, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31256607

RESUMEN

BACKGROUND: In June 2016, the Government of Canada passed Bill C-14 decriminalizing medically assisted death. Increasing numbers of Canadians are accessing medical assistance in dying (MAiD) each year, but there is limited information about this population. OBJECTIVE: To describe the characteristic outcomes of MAiD requests in a cohort of patients at an academic tertiary care center in Toronto, Ontario, Canada. METHODS: A retrospective chart review of patients making a formal request for a MAiD eligibility assessment from July 16 to September 18. Data extracted included demographics, diagnosis, psychosocial characteristics, information relating to the MAiD request, and clinical outcome. RESULTS: We received 107 formal requests for MAiD assessment. Ninety-seven patients were found eligible, of whom 80 received MAiD. Cancer was the primary diagnosis for 78% and median age was 74 years. The majority of patients (64%) cited "functional decline or inability to participate in meaningful activities" as the main factor motivating their request for MAiD. Half of patients who received MAiD (46%) described their request as consistent with a long-standing, philosophical view predating their illness. The 10-day reflection period was reduced for 39% of provisions due to impending loss of capacity. Our cohort was very similar demographically to those described both nationally and internationally. CONCLUSION: Patients seeking MAiD at our institution were similar to those described in other jurisdictions where assisted dying is legal and represent a group for whom autonomy and independence is critical. We noted a very high rate of risk of loss of capacity, suggesting a need for both earlier assessments and regular monitoring.


Asunto(s)
Rendimiento Físico Funcional , Participación Social , Suicidio Asistido/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Ontario , Cuidados Paliativos/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Factores Socioeconómicos , Suicidio Asistido/psicología , Centros de Atención Terciaria
12.
Pediatr Blood Cancer ; 67(1): e28013, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31612605

RESUMEN

BACKGROUND: There is growing evidence that palliative care (PC) is associated with increased quality of life in children with cancer. Despite increasing recommendations in support of PC to improve pediatric oncology care, little is known about its patterns of use. METHODS: We analyzed the 2005-2011 National Inpatient Sample, a representative, cross-sectional sample of US hospital admissions. Our study cohort comprised 10 960 hospitalizations of children with cancer and high in-hospital mortality risk. Survey-weighted regression models were constructed to determine associations of person- and hospital-level characteristics with PC involvement and healthcare costs. RESULTS: Overall, 4.4% of hospitalizations included PC involvement. In regression models invoking stepwise variable selection, a shorter length of stay (PC vs no PC; mean: 23.9 vs 32.6 days), solid cancer (solid vs hematologic vs brain cancer; PC use: 7.4% vs 2.8% vs 5.5%), and older age (PC vs no PC; mean: 10.2 vs 8.9 years) were associated with PC use. PC utilization was also associated with lower overall and daily hospital costs. CONCLUSIONS: One in 20 pediatric inpatients with cancer and high mortality risk receives PC, with differential utilization by socio-economic groups. These results have significant implications for public health resource allocation and the delivery of pediatric PC as high-value care. Future research should focus on the development of new tools to help physicians assess when PC is appropriate for their patients.


Asunto(s)
Niño Hospitalizado/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Mortalidad Hospitalaria/tendencias , Neoplasias/terapia , Cuidados Paliativos/estadística & datos numéricos , Adolescente , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Estudios de Seguimiento , Humanos , Lactante , Tiempo de Internación , Masculino , Neoplasias/patología , Neoplasias/psicología , Cuidados Paliativos/métodos , Pronóstico
13.
Support Care Cancer ; 28(1): 381-388, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31053972

RESUMEN

BACKGROUND: Music as a therapeutic tool, defined as "music care," can help manage physical and psychological symptoms in individuals with cancer. There is further need to understand interest level and the potential role of music care among health professionals working in the field of oncology. PURPOSE: To investigate knowledge of and attitudes toward the use of music as a therapeutic tool in cancer and palliative care, as well as to identify barriers associated with learning to use music in care among health professionals. METHODS: Participants (N = 204), mostly nurses working in oncology and palliative care, completed a survey to assess awareness, knowledge, and attitudes toward the use of music in healthcare practice. RESULTS: In total, 55.5% of participants reported being "somewhat or very knowledgeable" about how to apply/use music therapy for the management of symptoms or on how to make a music therapy referral or for any application of music care. Participants demonstrated a high interest level in learning how to incorporate music into practice (mean = 4.05; SD = 1.045). CONCLUSION: While there is generally high interest and perceived value among nurses in music care interventions, knowledge level about such interventions was low. The study has implications for knowledge translation and education needed to further support uptake and use of music care in nursing practice.


Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Musicoterapia , Neoplasias/terapia , Adulto , Estudios Transversales , Femenino , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Música/psicología , Neoplasias/psicología , Enfermeras y Enfermeros/psicología , Enfermeras y Enfermeros/estadística & datos numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/psicología , Cuidados Paliativos/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
14.
Support Care Cancer ; 28(1): 5-8, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31650294

RESUMEN

BACKGROUND: Gabapentinoid use for long-term cancer pain control may be problematic, given unclear mechanisms of action and increased concerns for physical dependence. The purpose of this report is to examine trends of gabapentinoid use among US adults with cancer from 2005 to 2015. METHODS: We conducted a serial, cross-sectional study using data from the Medical Expenditure Panel Survey (MEPS). We performed multiple logistic regression to examine the annual percentages of gabapentinoid users, which were adjusted for age, sex, and US region of residence. The amount of gabapentinoid prescriptions filled in 2015 was also estimated. RESULTS: The adjusted percentage of gabapentinoid users in 2015 was 5.60% (3.79%, 7.41%), 2.39 times greater than the percentage in 2005 (p < .001). By 2015, the number of gabapentinoid prescriptions had grown to approximately 3.52 million (2.40 million, 4.65 million). CONCLUSION: We observed greater than a twofold increase in the trend of gabapentinoid medication use among US adults with cancer. Investigations on the long-term efficacy of gabapentinoids for complex pain syndromes, and mitigation of risks, is essential to guide informed clinical management and keep patients safe.


Asunto(s)
Analgésicos/uso terapéutico , Dolor en Cáncer/tratamiento farmacológico , Gabapentina/uso terapéutico , Neoplasias/tratamiento farmacológico , Manejo del Dolor/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Dolor en Cáncer/epidemiología , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/epidemiología , Estudios Transversales , Femenino , Gabapentina/análogos & derivados , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Cuidados Paliativos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/etiología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
15.
Int J Radiat Oncol Biol Phys ; 106(1): 61-66, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31505246

RESUMEN

PURPOSE: To evaluate the use of single-fraction palliative radiation therapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia. METHODS AND MATERIALS: This is a population-based cohort of patients with cancer who received radiation therapy for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set. The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. RESULTS: Of the 18,158 courses of radiation therapy for BM delivered to a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P = .07). SFRT was less commonly given to the skull (4%) and spine (14%), compared with the shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared with those in major cities (22% vs 16%, P < .001). Patients treated in public institutions were more likely to have SFRT compared with those treated in private institutions (22% vs 10%, P < .001). In multivariable analyses, increasing age, lung cancer, higher socioeconomic status, residence in regional/ remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. CONCLUSIONS: SFRT appears underused for BM in Australia over time, with variation in practice by patient, tumor, sociodemographic, geographical, and institutional provider factors.


Asunto(s)
Neoplasias Óseas/radioterapia , Neoplasias Óseas/secundario , Cuidados Paliativos/métodos , Factores de Edad , Anciano , Anciano de 80 o más Años , Australia , Fraccionamiento de la Dosis de Radiación , Femenino , Neoplasias Gastrointestinales , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Neoplasias Pulmonares , Masculino , Persona de Mediana Edad , Cuidados Paliativos/estadística & datos numéricos , Neoplasias de la Próstata , Radioterapia/métodos , Radioterapia/estadística & datos numéricos , Dosificación Radioterapéutica , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Factores de Tiempo , Población Urbana/estadística & datos numéricos
16.
PLoS One ; 14(12): e0227305, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31887205

RESUMEN

We aimed to demonstrate a single institution experience of treatment of pancreatic ductal carcinoma and to identify the role of radiation therapy. We assessed all patients who were diagnosed with pancreatic ductal carcinoma from January 2011 to December 2017. A total of 342 patients were enrolled. Thirteen, 131, 36, and 162 patients had stage I, II, III, and IV disease, respectively (UICC TNM, 7th edition). Among the patients with stages I-III disease, 94 underwent surgery, and the median overall survival (OS) was 33 months. Of patients with stages I-III disease who were not suitable for surgery, 58 patients received chemotherapy, and the median OS was 12 months. Among them, 17 patients received chemoradiotherapy added on chemotherapy and their OS was significantly better than that of patients who received chemotherapy alone. Of patients with stage IV disease, 111 received chemotherapy, and the median OS was 6 months. This study evaluated the demand, role, and outcome of each treatment modality and demonstrated a single institution experience of treatment of pancreatic ductal carcinoma. The demand and role of radiation therapy remained small; however, radiation therapy might have some importance as a local treatment.


Asunto(s)
Carcinoma Ductal Pancreático/terapia , Quimioradioterapia/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Cuidados Paliativos/estadística & datos numéricos , Neoplasias Pancreáticas/terapia , Anciano , Anciano de 80 o más Años , Carcinoma Ductal Pancreático/mortalidad , Carcinoma Ductal Pancreático/patología , Quimioterapia Adyuvante/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pancreatectomía/estadística & datos numéricos , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Radioterapia Ayuvante/estadística & datos numéricos , Tasa de Supervivencia , Resultado del Tratamiento
17.
Medicina (B Aires) ; 79(5): 337-344, 2019.
Artículo en Español | MEDLINE | ID: mdl-31671382

RESUMEN

The international recommendations point to the early integration of palliative care (PC) in cancer through simultaneous care and training of primary teams. The PC Unit of the Hospital General de Agudos E. Tornú conducts interconsultations for hospitalized patients in the hospital and provides training to the treatment teams. The profile of the interconsultations carried out could provide important information about the characteristics of the PC intervention within the institution. The objective of this study was to retrospectively analyze the first-time interconsultations of cancer patients carried out over 2 years, focusing on temporality, identification of problems by the treating team and the PC interconsultation team, the promptness of response and the prognostic capacity of the latter. In the period, 168 interconsultations were carried out. Most patients had advanced disease, poor performance status, no possibility of oncological treatment and recent diagnosis. In approximately 25% of the cases, evidence of early intervention and participation of the pc team in decision making was found. The opportunity of PC intervention is discussed and areas needing improvement are indicated, such as the identification of non-physical symptoms and prognosis, to be considered in future care and educational activities.


Asunto(s)
Hospitales Generales/estadística & datos numéricos , Neoplasias/terapia , Cuidados Paliativos/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Hospitalización , Humanos , Masculino , Oncología Médica/estadística & datos numéricos , Persona de Mediana Edad , Neoplasias/mortalidad , Estudios Retrospectivos , Factores de Tiempo
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
19.
Wien Med Wochenschr ; 169(15-16): 387-393, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31728785

RESUMEN

The original English version of the palliative performance scale (PPS) has been used for two decades to describe the functional status of palliative patients. Based on clinical parameters PPS helps to estimate the survival time of palliative patients: the higher the functional status the longer the survival. This is interesting for patients, their family caregivers and health care professionals in order to plan for care. Until now there has not been published an official German version of the PPS.The functional status via a German version of the PPS of 394 patients of a palliative consulting team and their survival times were analyzed. Kaplan-Meier-curves were drawn and tested for differences. The hypothesis was tested if functional status using the German version of the PPS and survival are correlated. In this population differences in survival could clearly be shown for any category of PPS.This German version of the PPS is a useful and possible tool to estimate survival time of palliative patients using just clinical information.


Asunto(s)
Neoplasias , Cuidados Paliativos , Supervivientes de Cáncer/estadística & datos numéricos , Cuidadores , Humanos , Neoplasias/mortalidad , Cuidados Paliativos/estadística & datos numéricos , Pronóstico , Análisis de Supervivencia
20.
Medicine (Baltimore) ; 98(40): e17395, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31577748

RESUMEN

To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.


Asunto(s)
Neoplasias Hematológicas/epidemiología , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Cuidados Paliativos/organización & administración , Cuidado Terminal/organización & administración , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Comorbilidad , Femenino , Gastos en Salud/estadística & datos numéricos , Neoplasias Hematológicas/tratamiento farmacológico , Neoplasias Hematológicas/economía , Servicios de Atención de Salud a Domicilio/economía , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/economía , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/economía , Cuidados Paliativos/estadística & datos numéricos , Características de la Residencia , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Taiwán , Cuidado Terminal/economía , Cuidado Terminal/estadística & datos numéricos
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