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2.
J Contin Educ Nurs ; 52(3): 130-135, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33631023

RESUMO

BACKGROUND: COVID-19 has highlighted the need for universal palliative care access. Nurses require palliative care education throughout the trajectory of professional training to effectively achieve this vision. METHOD: Review of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and use of educational exemplars highlight opportunities for improving palliative nursing education in academic and clinical settings. RESULTS: Consistently applying palliative care principles affects nursing outcomes across myriad domains of person-centered services. All nurses are responsible for delivering primary palliative care, but they cannot practice what they do not know. The End-of-Life Nursing Education Consortium Project offers evidence-based education for nursing students and practicing nurses nationally and globally. CONCLUSION: Equipping both nurses and nursing students with palliative care education is critical to improve the overall quality of health care throughout the continuum during COVID-19 and in the face of future health crises. [J Contin Educ Nurs. 2021;52(3):130-135.].


Assuntos
/epidemiologia , Educação Continuada em Enfermagem/organização & administração , Saúde Global , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/educação , Cuidados Paliativos/normas , Currículo , Humanos , Pandemias , Guias de Prática Clínica como Assunto , Estados Unidos/epidemiologia
3.
Ann Hematol ; 100(3): 601-606, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388859

RESUMO

While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.


Assuntos
Prestação Integrada de Cuidados de Saúde , Neoplasias Hematológicas/terapia , Oncologia , Cuidados Paliativos , Equipe de Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Humanos , Comunicação Interdisciplinar , Oncologia/métodos , Oncologia/organização & administração , Oncologia/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas
4.
Bull Cancer ; 108(3): 284-294, 2021 Mar.
Artigo em Francês | MEDLINE | ID: mdl-33461728

RESUMO

INTRODUCTION: Many clinical practice guidelines on palliative sedation have been developed. To date, studies on French-language guidelines are lacking, despite the specific and potentially influential end-of-life positions taken by some French-speaking countries. This study aimed to perform a systematic review of the guidelines related to palliative sedation for adults in French-speaking countries, taking a synchronic and diachronic approach (current and former guidelines). METHODS: Guidelines published in French since 2000 were searched for multiple databases. In addition, prominent palliative care experts in French-speaking countries were contacted individually. A content analysis of all guidelines was conducted. RESULTS: A total of 21 guidelines from 18 countries were identified. Among them, at the time of the data collection, 14 guidelines were effectively compiled in four countries or provinces: Belgium, France, Canada (Quebec) and Switzerland. No guidelines were found for African countries. The recommendations analyzed were very heterogeneous in form (simple proposals or formal guidelines) and in substance (i.e. different types of sedation). DISCUSSION AND CONCLUSION: The quantity and volume of the guidelines found and the heterogeneity of the terminology prevented a detailed analysis of the content of the texts. An analysis must be performed using a synchronic approach only and focusing on a specific element of one type of sedation.


Assuntos
Hipnóticos e Sedativos/administração & dosagem , Idioma , Cuidados Paliativos/normas , Guias de Prática Clínica como Assunto/normas , África , Bélgica , França , Humanos , Quebeque , Suíça , Terminologia como Assunto
5.
BMC Palliat Care ; 20(1): 5, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407358

RESUMO

BACKGROUND: The aging of migrant populations across Europe challenges researchers in palliative care to produce knowledge that can be used to respond to the needs of the growing group of patients with a migration background and address ethnic disparities in palliative care. The aim of this study was to identify what factors influence researchers' efforts to address responsiveness of palliative care to patients with a migration background and other underserved populations in their projects. METHODS: We conducted semi-structured interviews with 11 researchers involved in seven projects under the Dutch national program for palliative care innovation. RESULTS: Researchers' efforts to address responsiveness of palliative care in their projects were influenced by individual factors, i.e. awareness of the need for responsiveness to patients with a migration background; experience with responsiveness; and, differences in perceptions on responsiveness in palliative care. Researchers' efforts were furthermore influenced by institutional factors, i.e. the interaction with healthcare institutions and healthcare professionals as they rely on their ability to identify the palliative patient with a migration background, address the topic of palliative care, and enrol these patients in research; scientific standards that limit the flexibility needed for responsive research; and, the responsiveness requirements set by funding agencies. CONCLUSION: Researchers play a key role in ensuring research addresses responsiveness to patients with a migration background. Such responsiveness may also benefit other underserved populations. However, at times researchers lack the knowledge and experience needed for responsive research. To address this we recommend training in responsiveness for researchers in the field of palliative care. We also recommend training for healthcare professionals involved in research projects to increase enrolment of patients with a migration background and other underrepresented populations. Lastly, we encourage researchers as well as research institutions and funding agencies to allow flexibility in research practices and set a standard for responsive research practice.


Assuntos
Emigrantes e Imigrantes , Disparidades em Assistência à Saúde/etnologia , Cuidados Paliativos/normas , Papel Profissional , Pesquisadores , Conscientização , Humanos , Área Carente de Assistência Médica , Países Baixos , Pesquisa Qualitativa , Melhoria de Qualidade , Qualidade da Assistência à Saúde
7.
Einstein (Sao Paulo) ; 18: eAO5539, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33053019

RESUMO

OBJECTIVE: To translate and make cross-cultural adaptation of NECPAL CCOMS-ICO© tool to Portuguese, and to analyze its semantic validity. METHODS: A methodological research about NECPAL CCOMS-ICO© tool cross-cultural adaptation, translated from Spanish into Portuguese and measurement of semantic validity. The cross-cultural adaptation process was conducted according to Beaton recommendations, including translation, translation synthesis, back-translation, and analysis of semantic, idiomatic, conceptual, and cultural equivalence of translated and back-translated tool versions, resulting in a pre-final version, which was submitted to a pre-test (n=35). Contend Validity Index was calculated to analyze semantic validity. RESULTS: Cross-cultural adaptation process allowed us to prepare the final version of this tool, which was named NECPAL-BR. Collected data from pre-testing step enabled the analysis of semantic validity. The Content Validity Index observed at this step was 0.94. CONCLUSION: The semantic validity of the tool in its Portuguese version was confirmed; therefore, it may assist in screening chronic progressive disease patients, aiming to provide early palliative care. It may also be used to develop clinical and team performance indicators, and be employed as a care management tool designed to optimize resources.


Assuntos
Comparação Transcultural , Cuidados Paliativos/normas , Semântica , Inquéritos e Questionários/normas , Humanos , Portugal , Reprodutibilidade dos Testes , Traduções
8.
Med. paliat ; 27(3): 234-241, jul.-sept. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197377

RESUMO

La pandemia de COVID-19 ha sido especialmente agresiva en el ámbito residencial, entorno donde la mortalidad supone más del 50 % del total de las muertes por esta enfermedad. Pero las repercusiones (físicas y emocionales) que esta crisis ha condicionado, tanto en los residentes como en sus familias y en los profesionales, van mucho más allá de estos datos. En primer lugar, y mediante la revisión de la (escasa) bibliografía existente, de los (escasos) datos disponibles en nuestro país y de la (intensa) experiencia vivida por parte de alguno de estos profesionales, en el presente artículo revisamos el impacto de la pandemia en este ámbito. En segundo lugar, se describen algunas propuestas desarrolladas con el objetivo de aportar respuesta a esta crisis, desde la perspectiva de los cuidados paliativos. Finalmente, y partiendo de las evidencias publicadas y de la propia experiencia, los autores formulan una serie de recomendaciones específicas y pragmáticas sobre la atención paliativa en el ámbito residencial, a corto, medio y largo plazo


The COVID-19 pandemic has been very aggressive in nursing homes, where mortality accounts for more than 50% of all deaths from this disease. But the physical and emotional repercussions go far beyond these data, both for residents and their families, and for professionals. Firstly, we review the impact of the pandemic in nursing homes based on a review of the existing literature, the data available in Spain, and the experience lived by some of these professionals. Secondly, some proposals developed by organizations with the objective of providing a response to this crisis from the palliative care perspective are described. Finally, and based on the published evidence and their own experience, the authors provide a series of specific and pragmatic recommendations on palliative care in nursing homes for the short, medium and long term


Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Cuidados Paliativos/métodos , Casas de Saúde/organização & administração , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Casas de Saúde/normas , Cuidados Paliativos/normas , Família/psicologia
9.
BMJ Open ; 10(8): e037466, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32759247

RESUMO

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.


Assuntos
Infecções por Coronavirus/terapia , Assistência de Longa Duração , Cuidados Paliativos/normas , Pandemias , Médicos , Pneumonia Viral/terapia , Instituições de Cuidados Especializados de Enfermagem , Assistência Terminal/normas , Adulto , Idoso , Alberta , Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/virologia , Família , Feminino , Idoso Fragilizado , Fragilidade , Necessidades e Demandas de Serviços de Saúde , Cuidados Paliativos na Terminalidade da Vida , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Pesquisa Qualitativa , Respeito , Especialização
10.
Palliat Med ; 34(9): 1249-1255, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32736493

RESUMO

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.


Assuntos
Infecções por Coronavirus/mortalidade , Delírio/tratamento farmacológico , Tratamento Farmacológico/normas , Dispneia/tratamento farmacológico , Cuidados Paliativos na Terminalidade da Vida/normas , Cuidados Paliativos/normas , Pneumonia Viral/mortalidade , Assistência Terminal/normas , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/enfermagem , Tratamento Farmacológico/estatística & dados numéricos , Feminino , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Morfina/uso terapêutico , Cuidados Paliativos/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/enfermagem , Guias de Prática Clínica como Assunto , Assistência Terminal/estatística & dados numéricos , Reino Unido/epidemiologia
11.
Am J Hosp Palliat Care ; 37(11): 980-984, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32691604

RESUMO

As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages is particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, our Geriatrics and Palliative (GAP) Medicine team formulated a 2-team approach which includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with or under investigation (PUI) for COVID-19. These algorithms provided a delineated set of guidelines to triage patients in need of palliative services and included provisions for acute symptoms management and the protection of both the patient care team and the families of patients with COVID-19. These guidelines helped with streamlining care in times of crisis, providing care to those in need, supporting frontline staff with primary-level palliative care, and minimizing the GAP team's risk of infection and burnout during the rapidly changing pandemic response.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Cuidados Paliativos/métodos , Pandemias , Planejamento de Assistência ao Paciente , Pneumonia Viral/terapia , Triagem/métodos , Algoritmos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Cuidados Paliativos/normas , Pandemias/prevenção & controle , Planejamento de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle
12.
J Gastrointest Cancer ; 51(3): 800-804, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32656628

RESUMO

PURPOSE: Today, the rapid outbreak of COVID-19 is the leading health issue. Patients with cancer are at high risk for the development of morbidities of COVID-19. Hence, oncology centers need to provide organ-based recommendations for optimal management of cancer in the COVID-19 era. METHODS: In this article, we have provided the recommendations on management of locally advanced rectal cancer during the COVID-19 pandemic based on our experience in Shohada-e Tajrish Hospital, Iran. RESULTS: We recommend that patients with locally advanced rectal cancer should be managed in an individualized manner in combination with local conditions related to COVID-19. CONCLUSION: Our recommendation may provide a guide for oncology centers of developing countries for better management of locally advanced rectal cancer.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/prevenção & controle , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Neoplasias Retais/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Betacoronavirus/isolamento & purificação , Quimioterapia Adjuvante/normas , Tomada de Decisão Clínica , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Controle de Infecções/normas , Irã (Geográfico)/epidemiologia , Oncologia/métodos , Terapia Neoadjuvante/normas , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Protectomia/normas , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia
13.
PLoS One ; 15(7): e0236390, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32702007

RESUMO

BACKGROUND: Nurses have a primary role in providing palliative and end-of-life (EOL) care. Their knowledge of EOL care, attitudes toward care of the dying, and palliative care self-efficacy are important in care delivery. Little is known regarding palliative care preparedness among Mongolian nurses. This study examines palliative care knowledge, attitude towards death and dying, and self-efficacy among Mongolian nurses, and examines predictors of self-efficacy. METHODS: A cross-sectional descriptive study was conducted. Participants were 141 nurses employed at the National Cancer Center in Mongolia. Data was collected using a self-administered questionnaire. RESULTS: The median score for the knowledge of palliative care was 8.0/20. "Psychosocial and spiritual care" was the lowest score on the palliative care knowledge subscale. The mean score for attitude toward care of the dying was 69.1%, indicating positive attitudes. The mean score for the palliative care self-efficacy was 33.8/48. Nurses reported low self-efficacy toward communicating with dying patients and their families, and managing delirium. Palliative care knowledge and duration of experience as an oncology nurse significantly predicted self-efficacy toward palliative care, accounting for 14.0% of the variance. CONCLUSIONS: Palliative education for nurses should address the knowledge gaps in EOL care and focus in increasing palliative care self-efficacy. Considering palliative care knowledge and nursing experience as an oncology nurse were significant predictors of self-efficacy toward palliative care, more effort is needed to fill the knowledge gaps in EOL care among nurses, especially for less experienced nurses.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/normas , Cuidados Paliativos/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Oncologia/tendências , Pessoa de Meia-Idade , Mongólia/epidemiologia , Dor/epidemiologia , Dor/patologia , Pacientes , Autoeficácia , Inquéritos e Questionários , Assistência Terminal
15.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32584447

RESUMO

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.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/terapia , Controle de Infecções/normas , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial/normas , Terapia Combinada , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Sistemas Multi-Institucionais , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Cuidados Paliativos/normas , Segurança do Paciente , Pennsylvania , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Assistência Terminal/normas , Centros de Atenção Terciária
16.
Palliat Support Care ; 18(4): 400-402, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32576325

RESUMO

The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has necessitated an interim restructuring of the healthcare system in accordance with public health preventive measures to mitigate spread of the virus while providing essential healthcare services to the public. This article discusses how the Palliative Care Team of the Komfo Anokye Teaching Hospital in Ghana has modified its services in accordance with public health guidelines. It also suggests a strategy to deal with palliative care needs of critically ill patients with COVID-19 and their families.


Assuntos
Infecções por Coronavirus/terapia , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/normas , Hospitais de Ensino/normas , Cuidados Paliativos/normas , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Betacoronavirus , Gana , Humanos , Pandemias
17.
JCO Glob Oncol ; 6: 844-851, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32552110

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has imposed a unique challenge to oncology patients and their treatment. There is no study related to the patients' preference for systemic therapy during this pandemic. We have conducted a prospective study to analyze that aspect. METHODS: All consecutive patients who visited during the lockdown period from April 1-10, 2020, for systemic chemotherapy were included in the study for a questionnaire-based survey to evaluate the willingness to continue chemotherapy during this pandemic and factors influencing the decisions. RESULTS: A total of 302 patients were included (median age, 56 years; range, 21-77 years). Most common sites of cancer were breast (n = 114), lung (n = 44), ovary (n = 34), and colon (n = 20). Home address was within the city for 125 patients (42%), outside the city for 138 (46%), and outside the state for 37 (12%). Treatment was curative in 150 patients and palliative in 152. Educational status was primary and above for 231 patients and no formal schooling for 71. A total of 203 patients wanted to continue chemotherapy, 40 wanted to defer, and 56 wanted the physician to decide. Knowledge about COVID-19 strongly correlated with intent of treatment (P = .01), disease status (P = .02), knowledge about immunosuppression (P < .001), home location (P = .02), and education status (P = .003). The worry about catching SARS-CoV-2 was high in those with controlled disease (P = .06) and knowledge about immunosuppression (P = .02). Worry about disease progression was more with palliative intent (P < .001). CONCLUSION: This study shows that oncology patients in our country are more worried about disease progression than the SARS-CoV-2 and wish to continue chemotherapy during this pandemic. The treatment guidelines in the COVID-19 scenario should incorporate patients' perspectives.


Assuntos
Betacoronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Imunoterapia/normas , Neoplasias/terapia , Cuidados Paliativos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Antineoplásicos Imunológicos/efeitos adversos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Progressão da Doença , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Cuidados Paliativos/estatística & dados numéricos , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
18.
Rev Mal Respir ; 37(6): 451-461, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32505369

RESUMO

INTRODUCTION: Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it. MATERIAL AND METHOD: A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory. RESULTS: A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease. CONCLUSION: Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach.


Assuntos
Cuidados Paliativos/psicologia , Cuidados Paliativos/estatística & dados numéricos , Percepção , Padrões de Prática Médica/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Pneumologistas , Adulto , Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/normas , Relações Médico-Paciente , Padrões de Prática Médica/normas , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Pneumologia/normas , Pneumologia/estatística & dados numéricos , Pneumologistas/psicologia , Pneumologistas/estatística & dados numéricos , Qualidade de Vida , Assistência Terminal/métodos , Assistência Terminal/psicologia , Assistência Terminal/estatística & dados numéricos
19.
J Am Geriatr Soc ; 68(7): 1370-1375, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32392624

RESUMO

Early on, geriatricians in Israel viewed with increasing alarm the spread of coronavirus disease 2019 (COVID-19). It was clear that this viral disease exhibited a clear predilection for and danger to older persons. Informal contacts began with senior officials from the country's Ministry of Health, the Israel Medical Association, and the country's largest health fund; this was done to plan an approach to the possible coming storm. A group was formed, comprising three senior geriatricians, a former dean, a palliative care specialist, and a lawyer/ethicist. The members made every effort to ensure that their recommendations would be practical while at the same time taking into account the tenets of medical ethics. The committee's main task was to think through a workable approach because intensive care unit/ventilator resources may be far outstripped by those requiring such care. Recommendations included the approach to older persons both in the community and in long-term care institutions, a triage instrument, and palliative care. Patient autonomy was emphasized, with a strong recommendation for people of all ages to update their advance directives or, if they did not have any, to quickly draw them up. Considering the value of distributive justice, with respect to triage, a "soft utilitarian" approach was advocated with the main criteria being function and comorbidity. Although chronological age was rejected as a sole criterion, in the case of an overwhelming crisis, "biological age" would enter into the triage considerations, but only in the case of distinguishing between people with equal non-age-related deficits. The guideline emphasized that no matter what, in the spirit of beneficence, anyone who fell ill must receive active palliative care throughout the course of a COVD-19 infection but especially at the end of life. Furthermore, in the spirit of nonmaleficence, the frail, very old, and severely demented would be actively protected from dying on ventilation. J Am Geriatr Soc 68:1370-1375, 2020.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Geriatria/normas , Serviços de Saúde para Idosos/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Israel , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Masculino , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Triagem/métodos , Triagem/normas
20.
J Pediatr ; 222: 186-192.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32417078

RESUMO

OBJECTIVE: Within the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), a learning health network developed to improve outcomes for patients with hypoplastic left heart syndrome and variants, we assessed which centers contributed to reductions in mortality and growth failure. STUDY DESIGN: Centers within the NPC-QIC were divided into tertiles based on early performance for mortality and separately for growth failure. These groups were evaluated for improvement from the early to late time period and compared with the other groups in the late time period. RESULTS: Mortality was 3.8% for the high-performing, 7.6% for the medium-performing, and 14.4% for the low-performing groups in the early time period. Only the low-performing group had a significant change (P < .001) from the early to late period. In the late period, there was no difference in mortality between the high- (5.7%), medium- (7%), and low- (4.6%) performing centers (P = .5). Growth failure occurred in 13.9% for the high-performing, 21.9% for the medium-performing, and 32.8% for the low-performing groups in the early time period. Only the low-performing group had a significant change (P < .001) over time. In the late period, there was no significant difference in growth failure between the high- (19.8%), medium- (21.5%), and low- (13.5%) performing groups (P = .054). CONCLUSIONS: Improvements in the NPC-QIC mortality and growth measures are primarily driven by improvement in those performing the worst in these areas initially without compromising the success of high-performing centers. Focus for improvement may vary by center based on performance.


Assuntos
Educação em Saúde , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Procedimentos de Norwood/métodos , Cuidados Paliativos/normas , Melhoria de Qualidade , Sistema de Registros , Feminino , Humanos , Síndrome do Coração Esquerdo Hipoplásico/mortalidade , Lactente , Masculino , Estudos Retrospectivos
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