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2.
Pan Afr Med J ; 35(Suppl 2): 130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193945

RESUMO

The COVID-19 pandemic has strained health care systems beyond capacity resulting in many people not having access to life-sustaining measures even in well-resourced countries. Palliative and end-of-life care are therefore essential to alleviate suffering and ensure a continuum of care for patients unlikely to survive. This is challenging in sub-Saharan Africa where lack of trained teams on basic palliative care and reduced access to opioids limit implementation of palliative and end-of-life care. At the same time, health care providers have to cope with local cultural conceptions of death and absence of advance care directives.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/organização & administração , Pandemias , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Diretivas Antecipadas , África ao Sul do Saara/epidemiologia , Analgésicos Opioides/provisão & distribução , Analgésicos Opioides/uso terapêutico , Atitude Frente a Morte , Barreiras de Comunicação , Continuidade da Assistência ao Paciente , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Cultura , Acesso aos Serviços de Saúde , Humanos , Cuidados Paliativos/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Relações Profissional-Paciente , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/mortalidade , Estigma Social , Assistência Terminal/psicologia
5.
Br J Nurs ; 29(17): 1044-1045, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32972231

RESUMO

Lauren Oliver, formerly Clinical Nurse Advisor, NHS Nightingale North West, outlines the challenges faced by staff in providing good-quality end-of-life care for patients in a temporary hospital during the initial peak of the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/terapia , Hospitais Estaduais , Pandemias , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Infecções por Coronavirus/epidemiologia , Humanos , Recursos Humanos em Hospital/psicologia , Pneumonia Viral/epidemiologia , Medicina Estatal/organização & administração , Reino Unido/epidemiologia
7.
Palliat Med ; 34(9): 1182-1192, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736494

RESUMO

BACKGROUND: The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. AIM: To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. DESIGN: Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. DATA SOURCES: Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. RESULTS: Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to 'systems' (community providers feeling disadvantaged in terms of receiving timely information and protocols), 'space' (recognised need for more care in the community), 'staff' (training needs and resilience) and 'stuff' (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). CONCLUSIONS: As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Pessoal de Saúde/psicologia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/organização & administração , Cuidados Paliativos/organização & administração , Pneumonia Viral/terapia , Atenção Primária à Saúde/organização & administração , Assistência Terminal/organização & administração , Adulto , Epidemias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Papel Profissional
8.
Eur J Cancer ; 136: 95-98, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32653775

RESUMO

The lack of integration between public health approaches, cancer care and palliative and end-of-life care in the majority of health systems globally became strikingly evident in the context of the coronavirus disease 2019 (COVID-19) pandemic. At the same time, the collapse of the boundaries between these domains imposed by the pandemic created unique opportunities for intersectoral planning and collaboration. While the challenge of integration is not unique to oncology, the organisation of cancer care and its linkages to palliative care and to global health may allow it to be a demonstration model for how the problem of integration can be addressed. Before the pandemic, the large majority of individuals with cancer in need of palliative care in low- and middle-income countries and the poor or marginalised in high-income countries were denied access. This inequity was highlighted by the COVID-19 pandemic, as individuals in impoverished or population-dense settings with weak health systems have been more likely to become infected and to have less access to medical care and to palliative and end-of-life care. Such inequities deserve attention by government, financial institutions and decision makers in health care. However, there has been no framework in most countries for integrated decision-making that takes into account the requirements of public health, clinical medicine and palliative and end-of-life care. Integrated planning across these domains at all levels would allow for more coordinated resource allocation and better preparedness for the inevitability of future systemic threats to population health.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde , Oncologia/organização & administração , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Pneumonia Viral/epidemiologia , Saúde Pública , Assistência Terminal/organização & administração , Betacoronavirus , Acesso aos Serviços de Saúde , Humanos , Pandemias
10.
Hastings Cent Rep ; 50(3): 58-60, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596896

RESUMO

In recent months, Covid-19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long-standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end-of-life care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision-making. In the midst of the Covid-19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race-neutral algorithms sacrifice black lives. Is there such thing as a "good" or "dignified" death when African Americans are dying not merely of Covid-19 but of structural racism?


Assuntos
Afro-Americanos , Infecções por Coronavirus/epidemiologia , Disparidades em Assistência à Saúde/etnologia , Cuidados Paliativos/organização & administração , Pneumonia Viral/epidemiologia , Assistência Terminal/organização & administração , Betacoronavirus , Alocação de Recursos para a Atenção à Saúde/ética , Disparidades em Assistência à Saúde/ética , Humanos , Cuidados Paliativos/ética , Pandemias , Racismo , Determinantes Sociais da Saúde/ética , Determinantes Sociais da Saúde/etnologia , Justiça Social , Assistência Terminal/ética , Confiança , Estados Unidos/epidemiologia
11.
Hastings Cent Rep ; 50(3): 71-72, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596902

RESUMO

Ethicists and physicians all over the world have been working on triage protocols to plan for the possibility that the Covid-19 pandemic will result in shortages of intensive care unit beds, ventilators, blood products, or medications. In reflecting on those protocols, many health care workers have noticed that, outside the pandemic shortage situation, we routinely supply patients in the ICU with invasive and painful care that will not help the patients survive even their hospitalization. This is the kind of pointless care that even the most basic protocol would triage against. Perhaps this widespread reflection on triage standards will draw our attention to our ongoing custom of supplying burdensome and inefficacious care to those near the end of life-care that most health care providers would not want for themselves. This essay argues that reflecting on triage could help us improve end-of-life care.


Assuntos
Infecções por Coronavirus/epidemiologia , Alocação de Recursos para a Atenção à Saúde/ética , Unidades de Terapia Intensiva/ética , Pneumonia Viral/epidemiologia , Assistência Terminal/ética , Triagem/ética , Betacoronavirus , Alocação de Recursos para a Atenção à Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Assistência Terminal/organização & administração , Triagem/organização & administração
12.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32394338

RESUMO

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.


Assuntos
Infecções por Coronavirus/terapia , Cuidados Críticos/organização & administração , Pneumonia Viral/terapia , Assistência Terminal/organização & administração , Anestesiologistas/organização & administração , Anestesiologistas/normas , Competência Clínica , Infecções por Coronavirus/mortalidade , Cuidados Críticos/normas , Humanos , Cuidados Paliativos/organização & administração , Pandemias , Médicos/organização & administração , Médicos/normas , Pneumonia Viral/mortalidade , Assistência Terminal/normas , Suspensão de Tratamento
13.
Anesth Analg ; 130(6): 1504-1515, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384340

RESUMO

Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their nonfrail peers. Palliative care is an interdisciplinary medical specialty focused on improving quality of life for patients with serious illness, including those with frailty, throughout their disease course. Anesthesiology providers will frequently encounter frail patients in the perioperative period and in the intensive care unit (ICU) and can contribute to improving the quality of life for these patients through the provision of palliative care. We highlight the opportunities to incorporate primary palliative care, including basic symptom management and straightforward goals-of-care discussions, provided by the primary clinicians, and when necessary, timely consultation by a specialty palliative care team to assist with complex symptom management and goals-of-care discussions in the face of team and/or family conflict. In this review, we apply the principles of palliative care to patients with frailty and synthesize the evidence regarding methods to integrate palliative care into the perioperative and ICU settings.


Assuntos
Fragilidade/terapia , Cuidados Paliativos/organização & administração , Idoso , Anestesiologia/tendências , Cuidados Críticos , Idoso Fragilizado , Fragilidade/psicologia , Humanos , Unidades de Terapia Intensiva , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Período Perioperatório , Angústia Psicológica , Qualidade de Vida , Assistência Terminal/organização & administração , Resultado do Tratamento
14.
Rev Infirm ; 69(257): 27-28, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146961

RESUMO

Cystic fibrosis is a chronic disease detected at birth that requires multidisciplinary follow-up throughout life. Two singular stories guide us in the reflection on end-of-life care. Firstly, it is a painful stage when it comes to giving up lung transplantation. The care receiver also wants continuity of care in line with his or her philosophy of life. The partnership of the caregivers with the ethical space and/or palliative care of the hospital becomes a necessary third party for a more peaceful end of life.


Assuntos
Fibrose Cística/terapia , Apoio Social , Assistência Terminal/organização & administração , Humanos
15.
BMC Palliat Care ; 19(1): 31, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164672

RESUMO

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.


Assuntos
Tomada de Decisão Compartilhada , Serviço Hospitalar de Oncologia/normas , Encaminhamento e Consulta/normas , Fatores de Tempo , Idoso , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normas , Prestação Integrada de Cuidados de Saúde/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/terapia , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/tendências , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Cuidados Paliativos/tendências , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Assistência Terminal/organização & administração , Assistência Terminal/normas , Assistência Terminal/tendências
19.
J Clin Oncol ; 38(9): 937-943, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32023154

RESUMO

Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer.Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient's death compared with people who did not have access to these services.Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.


Assuntos
Cuidadores/psicologia , Família/psicologia , Cuidados Paliativos na Terminalidade da Vida/normas , Neoplasias/psicologia , Apoio Social , Assistência Terminal/normas , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Assistência Terminal/organização & administração , Assistência Terminal/psicologia
20.
J Clin Oncol ; 38(9): 944-953, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32023164

RESUMO

Hematologic malignancies are a heterogeneous group of diseases with unique illness trajectories, treatment paradigms, and potential for curability, which affect patients' palliative and end-of-life care needs. Patients with hematologic malignancies endure immense physical and psychological symptoms because of both their illness and often intensive treatments that result in significant toxicities and adverse effects. Compared with patients with solid tumors, those with hematologic malignancies also experience high rates of hospitalizations, intensive care unit admissions, and in-hospital deaths and low rates of referral to hospice as well as shorter hospice length of stay. In addition, patients with hematologic malignancies harbor substantial misperceptions about treatment risks and benefits and frequently overestimate their prognosis. Even survivors of hematologic malignancies struggle with late effects, post-treatment complications, and post-traumatic stress symptoms that can significantly diminish their quality of life. Despite these substantial unmet needs, specialty palliative care services are infrequently consulted for the care of patients with hematologic malignancies. Several illness-specific, cultural, and system-based barriers to palliative care integration and optimal end-of-life care exist in this population. However, recent evidence has demonstrated the feasibility, acceptability, and efficacy of integrating palliative care to improve the quality of life and care of patients with hematologic malignancies and their caregivers. More research is needed to develop and test population-specific palliative and supportive care interventions to ensure generalizability and to define a sustainable clinical delivery model. Future work also should focus on identifying moderators and mediators of the effect of integrated palliative care models on patient-reported outcomes and on developing less resource-intensive integrated care models to address the diverse needs of this population.


Assuntos
Cuidadores/psicologia , Família/psicologia , Neoplasias Hematológicas/psicologia , Cuidados Paliativos/normas , Apoio Social , Assistência Terminal/normas , Humanos , Cuidados Paliativos/psicologia , Prognóstico , Qualidade de Vida , Assistência Terminal/organização & administração , Assistência Terminal/psicologia
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