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1.
Medicine (Baltimore) ; 100(12): e24320, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761631

RESUMO

ABSTRACT: Palliative care is a central component of the therapy in terminally ill patients. During treatment in non-palliative departments this can be realized by consultation.To analyze the change in symptom burden during palliative care consultation.In this observational study, we enrolled all cancer cases (n = 163) receiving inpatient treatment for 2015 to 2018 at our institution. We used the MDASI-questionnaire (0 = 'not present' and 10 = "as bad as you can imagine") and the FAMCARE-6 (1 = very satisfied, 5 = very dissatisfied) to analyze the treatment effect and patient satisfaction, respectively.We examined the association of symptom burden and patient satisfaction using Spearman-correlation. Comparing mean values, we applied the Wilcoxon-test and one-way ANOVA.An improvement in MDASI-core-items after treatment completion was significant (P < .05) in 14/18 symptoms. The change in perception of pain showed the strongest improvement (median: 5 to 3). Initially the MDASI-items "activity" (median = 8) and emotional distress (median = 5 and 6) were viewed as especially incriminating. There was no evidence for a correlation between patients' age, the type of diagnosis and time since diagnosis.The analysis of FAMCARE-6 patient contentment was lower or equal to two in all of the six items. There was a weak negative association between the change in symptom burden of psycho-emotional items "distress/feeling upset" (P = .006, rSp = -0,226), "sadness" and patient satisfaction in FAMCARE-6.A considerable improvement of the extensive symptom burden particularly of pain relief was achieved by integrating palliative consultation in clinical practice.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Cuidados Paliativos/psicologia , Satisfação do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/diagnóstico , Dor do Câncer/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/psicologia , Medição da Dor/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Doente Terminal/psicologia , Doente Terminal/estatística & dados numéricos , Resultado do Tratamento
2.
Age Ageing ; 50(2): 294-306, 2021 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-33336701

RESUMO

INTRODUCTION: The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults. In the context of COVID-19, decision-making surrounding place of care (PoC) and place of death (PoD) in older adults involves significant new challenges. AIMS: To explore key factors that influence PoC and PoD decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19. METHODS: Rapid review of reviews, undertaken using WHO guidance for rapid reviews for the production of actionable evidence. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation. RESULTS: 10 papers were included for full data extraction. These papers were published between 2005 and 2020. Papers included discussed actual PoD, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. CONCLUSIONS: The process and outcomes of decision-making for older people are affected by many factors-all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.


Assuntos
Tomada de Decisão Compartilhada , Cuidados Paliativos , Assistência Terminal , Adaptação Psicológica , Idoso , /psicologia , Idoso Fragilizado , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia
3.
Psicooncología (Pozuelo de Alarcón) ; 17(2): 227-237, jul.-dic. 2020.
Artigo em Espanhol | IBECS | ID: ibc-199113

RESUMO

El sufrimiento aparece de manera natural y espontánea cuando no tenemos recursos para hacer frente a una situación que se convierte en una amenaza. Acompañar el sufrimiento no es tarea fácil y requiere destrezas, habilidades y conocimientos, así como desarrollo personal. Identificar y abordar el sufrimiento es una de las principales funciones de la práctica clínica. Poder identificar cómo esta experiencia afecta a los profesionales sanitarios, así como generar estrategias para hacerle frente podría protegernos y facilitar el ejercicio de la ayuda. Este artículo tiene como objetivo principal realizar una revisión teórica, acompañada de claves prácticas, para presentar cinco cuestiones previas que configuran un conocimiento esencial para el acompañamiento. Se pretende estimular la reflexión y el aprendizaje de habilidades que nos permitan desarrollar nuestras acciones desde la consciencia y en coherencia con nuestros valores y objetivos


Suffering appears naturally and spontaneously when we do not have resources to deal with a threat. Accompanying suffering is not an easy task and requires skills, abilities and knowledge, as well as personal development. Identifying and addressing suffering is one of the main functions in clinical practice. To be able to identify how this experience affects healthcare professionals, and to generate strategies to face it, could protect us and facilitate the exercise of helping others. The main objective of this article is to realize a theoretical review, accompanied by practical keys, in order to present five previous questions that constitute an essential knowledge for accompaniment. It is intended to stimulate reflection and learning skills that allow us to develop our actions from consciousness and in coherence with our values and objectives


Assuntos
Humanos , Atitude do Pessoal de Saúde , Estresse Psicológico , Medo/psicologia , Meditação , Responsabilidade Social , Cuidados Paliativos/psicologia
4.
Psicooncología (Pozuelo de Alarcón) ; 17(2): 357-373, jul.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199120

RESUMO

INTRODUCCIÓN: Los pacientes con enfermedades crónicas en fase avanzada tienen numerosas necesidades psicológicas, sociales y espirituales, como resultado de su estado físico, condición, curso terapéutico y efectos secundarios del tratamiento, además de distrés psicológico y existencial por lo que la figura del psicólogo en Cuidados Paliativos tiene una gran relevancia. OBJETIVO: Realizar un análisis situacional de los psicólogos integrados a los equipos de cuidados paliativos del sector público en México. MÉTODO: Estudio prospectivo, descriptivo y transversal. Se diseño una encuesta ex profeso de 22 reactivos con respuesta dicotómica y opción múltiple. RESULTADOS: Se analizaron un total de 49 encuestas de psicólogos que prestan sus servicios en unidades de atención médica en México, a través de análisis de frecuencias y porcentajes, chi cuadrada y w de wilcoxon. CONCLUSIONES: Los psicólogos en cuidados paliativos requieren formación y capacitación formal para desarrollar habilidades y competencias específicas en este contexto; y de mayor sistematización y de protocolos de manejo en las evaluaciones e intervenciones psicológicas en el paciente de cuidados paliativos y su familia para evidenciar la contribución de la Psicología en Cuidados Paliativos


INTRODUCTION: Advanced chronic diseases patients have psychological, social and spiritual needs, as a result of their physical state, medical treatments, side effects, psychological and existential distress, so psychologists have great relevance in Palliative Care. OBJECTIVE: Analyze the situation of the psychologists in the palliative care teams of public health units in Mexico. Method. Prospective, descriptive and cross-sectional study. An express survey of 22 items was designed with dichotomous response and multiple choice. RESULTS: Analyzed 49 surveys of psychologists who provide services in medical care units in Mexico: analysis of frequencies, percentages, chi squared and ranks test ́ Wilcoxon. CONCLUSIONS: Palliative care psychologists require formal education and training to develop specific skills and competencies in this context; systematization and management protocols in evaluations and psychological interventions for patients and their families to demonstrate the contribution of psychologist in palliative care


Assuntos
Humanos , Cuidados Paliativos/psicologia , Psicologia , Estudos Transversais , Estudos Prospectivos , Setor Público , México
5.
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
7.
PLoS One ; 15(10): e0238357, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33027265

RESUMO

BACKGROUND: Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in the final stages of their life. Lack of knowledge of and negative attitude palliative care among nurses is one of the most common barriers to quality palliative care. This study, therefore, aimed to assess nurses' knowledge about palliative care and attitude toward end-of-life care in public hospitals in Wollega zones, Ethiopia. METHODS: A multicenter institutional-based cross-sectional study design was employed to collect data from 372 nurses working in public hospitals in Wollega zones from October 02-22, 2019. A self-administered questionnaire with three different parts: Demographic characteristics of nurses, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Towards Care of the Dying (FATCOD). SPSS version 21 was used for analysis used for data analysis. The binary logistic regression test was used for analysis at p < 0.05. FINDINGS: Our final sample size was 422 nurses (response rate = 88%). With the mean total PCQN scores (9.34), the majority of them showed an inadequate level of knowledge about palliative care. The mean total FATCOD scores (79.58) displayed a positive attitude toward end-of-life care, with 52% of respondents eager to care for a dying person and their family. Nurses who had PC service experience [AOR = 1.94 CI (1.10-3.42), p = 0.02] and had ever attended training/lecture on PC [AOR = 1.87 CI (1.01-3.46), p = 0.04] were independently associated with nurses' knowledge about PC. Similarly, nurses who had no PC service experience [AOR = 0.41, CI (0.21-0.79), p = 0.008], who read articles/brochures about PC [AOR = 1.94, CI (1.11-3.39), p = 0.01] and had provided care for a smaller number of terminally ill patients [AOR = 1.74, CI (1.01-2.97), p = 0.04] were significantly associated with nurses' attitude towards end-of-life care. CONCLUSION: The study highlighted that nurses' knowledge about palliative care is inadequate, and showed a less favorable attitude toward end-of-life care. The findings also provide evidence for greater attentions and resources should be directed towards educating and supporting nurses caring for patients with palliative care needs in Wollega Zones.


Assuntos
Atitude do Pessoal de Saúde , Papel do Profissional de Enfermagem , Cuidados Paliativos , Assistência Terminal , Adulto , Estudos Transversais , Educação em Enfermagem , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem/psicologia , Cuidados Paliativos/psicologia , Inquéritos e Questionários , Assistência Terminal/psicologia , Adulto Jovem
9.
Med. paliat ; 27(3): 201-208, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197373

RESUMO

OBJETIVO: Favorecer que cada persona elabore su duelo de forma natural, prevenir factores de riesgo e identifi car a los deudos que necesiten una atención específica. MÉTODO: Estudio descriptivo. Doscientas ocho familias fueron atendidas entre el 11 de marzo y el 20 de mayo de 2020 por duelo por la COVID-19, de acuerdo con un protocolo establecido. RESULTADOS: La edad media de los fallecidos fue de 76 años. El 58 % eran hombres. Los familiares atendidos fueron hijo/a (54 %), cónyuge o pareja (20 %), hermano/a (2 %). En relación con el lugar de fallecimiento, el 41 % en plantas de hospitalización, el 27 % en Urgencias, el 22 % en la planta de cuidados paliativos y el 10 % en UCI. El tipo de atención fue en el 53 % de los casos telefónica, en el 16 % presencial, en el 12 % telefónica y presencial y en el 3 % a través de videollamada. En un 63 % de las veces se realizó apoyo, asesoramiento puntual o atención específica mientras que en el 37 % se ofreció apoyo y disponibilidad. En lo referente "despedida final", el 49 % de los familiares pudieron despedirse, el 31 % no pudo. El tipo de duelo de los familiares atendidos fue inicialmente normal en el 71 %, mientras que un 16 % fue clasificado como de riesgo. CONCLUSIONES: La información y comunicación efectiva con los familiares afectados, la formación en la muerte y el duelo de los profesionales implicados y la disponibilidad de atención psicológica se consideran de gran importancia en una situación COVID-19. La experiencia muestra que la "Atención al duelo" debe estar a disposición de la población general afectada. Una buena organización y planificación ha de incorporar protocolos de actuación y seguimiento que incluyan una adecuada valoración y atención en los diferentes niveles desde el apoyo, la prevención y la detección precoz de posibles complicaciones en el duelo, y si es necesario la intervención especializada


OBJECTIVE: To allow each individual to undergo bereavement in a natural way, to prevent risk factors, and to identify bereaved people who need specific attention. METHOD: A descriptive study. Two hundred and eight families were attended to between March 11 and May 20, 2020 for Covid-19 according to an established protocol. RESULTS: Average age of the deceased relatives was 76 years. Fifty-eight percent were men. The family members who were cared for included: son or daughter (54 %), spouse or partner (20 %), brother or sister (2 %). Regarding the place of death, 41 % were in hospitalization wards, 27 % in the emergency room, 22 % in the palliative care ward, and 10 % in the ICU. The method of care was in 53 % of cases over the telephone, in 16 % in person, and in 12 % both over the telephone and in person; in 3 % of cases it was by video call. In 63 % of cases, support, specific advice or care was provided, whereas in 37 % support and availability were offered. In terms of "final goodbye", 49 % of all family members were able to say goodbye, while 31 % were unable to do so. The type of grief observed in the family members attended to was initially considered to be normal for 71 % of cases, whereas 16 % were classified as at risk. DISCUSSION: Effective information to and communication with affected relatives; that involved professionals be trained in dealing with death and grief so as not to cause harm, as well as in palliative care; and availability of psychological care are deemed of great importance in a COVID-19 scenario. Experience shows that "bereavement care" should be available to the general affected population. Proper organization and planning must incorporate action and follow-up protocols that include adequate assessment and care at different levels, from support, prevention and early detection of possible complications of bereavement to specialist intervention when necessary


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pesar , Infecções por Coronavirus , Pandemias , Família/psicologia , Pacientes/psicologia , Cuidados Paliativos/psicologia , Adaptação Psicológica , Pneumonia Viral , Betacoronavirus , Fatores de Risco , Telefone , Emoções
12.
Med Clin North Am ; 104(5): 767-775, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773044

RESUMO

Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.


Assuntos
Tomada de Decisão Compartilhada , Cuidados Paliativos , Planejamento de Assistência ao Paciente , Idoso , Competência Clínica , Humanos , Cuidados Paliativos/ética , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Planejamento de Assistência ao Paciente/ética , Planejamento de Assistência ao Paciente/normas , Relações Médico-Paciente
13.
PLoS One ; 15(8): e0238023, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833987

RESUMO

BACKGROUND: Palliative care is an essential part of medical practice but it remains limited, inaccessible, or even absent in low and middle income countries. OBJECTIVES: To evaluate the general knowledge, attitudes, and practices of Mozambican physicians on palliative care. METHODS: A cross-sectional observational study was conducted between August 2018 and January 2019 in the 3 main hospitals of Mozambique, in addition to the only hospital with a standalone palliative care service. Data was collected from a self-administered survey directed to physicians in services with oncology patients. RESULTS: Two hundred and seven out of 306 physicians surveyed answered the questionnaire. The median physician age was 38 years. Fifty-five percent were males, and 49.8% residents. The most common medical specialty was surgery with 26.1%. Eighty percent of physicians answered that palliative care should be provided to patients when no curative treatments are available; 87% believed that early integration of palliative care can improve patients' quality of life; 73% regularly inform patients of a cancer diagnosis; 60% prefer to inform the diagnosis and prognosis to the family/caregivers. Fifty percent knew what a "do-not-resuscitate" order is, and 51% knew what palliative sedation is. Only 25% of the participants answered correctly all questions on palliative care general knowledge, and only 24% of the participants knew all answers about euthanasia. CONCLUSIONS: Mozambican physicians in the main hospitals of Mozambique have cursory knowledge about palliative care. Paternalism and the family-centered model are the most prevalent. More interventions and training of professionals are needed to improve palliative care knowledge and practice in the country.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos/psicologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moçambique , Cuidados Paliativos/estatística & dados numéricos , Inquéritos e Questionários
14.
Palliat Support Care ; 18(4): 382-384, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32631469

RESUMO

OBJECTIVE: The COVID-19 pandemic is a care crisis of unknown duration which has seemingly not yet reached its peak in many countries. A significant number of elderly and frail people and those with underlying serious illness will continue to develop severe forms of the COVID-19 infection. Most of them are not eligible for intensive care treatment but can still expect palliative care - in many cases provided by a Hospital Palliative Care Team (HPCT). Several teams have already gained experience in caring for these patients and their families, others are preparing for it. METHOD: We report on a COVID-19 patient with pre-existing acute myeloid leukemia who was looked after by a HPCT until death. We discuss the challenges and difficulties while caring for COVID-19-positive palliative patients in a non-ICU setting. RESULTS: Hospitalization of the patient in an isolation ward caused an enormous burden for the dying patient and his family. Symptom control was particularly difficult because of rapid deteriorating dyspnea and the scarce presence of medical staff in the patient's room. SIGNIFICANCE OF RESULTS: COVID-19 patients who are not eligible for ICU treatment may have a particularly high need for palliative care. Since beds in specialist palliative care units are limited, the HPCT should be prepared to care for these patients. They may offer support in decision-making, optimize symptom control, and provide psychosocial care for patients and their families. Visiting restrictions aimed to protect the general public must be weighted against the patient's and family's suffering.


Assuntos
Atitude Frente a Morte , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/psicologia , Pessoal de Saúde/psicologia , Cuidados Paliativos/psicologia , Pneumonia Viral/mortalidade , Pneumonia Viral/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente
15.
Ned Tijdschr Geneeskd ; 1642020 06 19.
Artigo em Holandês | MEDLINE | ID: mdl-32608929

RESUMO

Total parenteral nutrition may be considered for a carefully selected group of palliative patients with ileus. Predictive factors include a strong desire to live, low burden of disease other than the ileus and expected increase in quality of life as a result of starting with total parenteral nutrition. Therapy compliance is required and a strong social network is desirable. Close collaboration between hospital and general practitioners and frequent reviews of the palliative care plan are also required for success.


Assuntos
Íleus/terapia , Enteropatias/terapia , Cuidados Paliativos/métodos , Nutrição Parenteral Total/métodos , Feminino , Humanos , Íleus/psicologia , Enteropatias/psicologia , Masculino , Cuidados Paliativos/psicologia , Nutrição Parenteral Total/psicologia , Cooperação do Paciente , Qualidade de Vida , Apoio Social
17.
Psychol Trauma ; 12(S1): S146-S147, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32538660

RESUMO

The COVID-19 pandemic has changed the way doctors approach palliative and end-of-life care, which has undoubtedly affected the mental health of patients, families, and health care professionals. Given these circumstances, doctors working on the front line are vulnerable to moral injury and compassion fatigue. This is a reflection of 2 junior doctors experiencing firsthand demands of caring for patients during the outbreak. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Fadiga por Compaixão , Infecções por Coronavirus/terapia , Corpo Clínico Hospitalar , Cuidados Paliativos , Pandemias , Pneumonia Viral/terapia , Relações Profissional-Família , Trauma Psicológico , Assistência Terminal , Adulto , Fadiga por Compaixão/etiologia , Fadiga por Compaixão/psicologia , Inglaterra , Humanos , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/psicologia , Princípios Morais , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Relações Profissional-Família/ética , Trauma Psicológico/etiologia , Trauma Psicológico/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia
18.
PLoS One ; 15(6): e0234926, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559237

RESUMO

BACKGROUND: Communication and shared decision-making (SDM) are essential to patient-centered care. Hospital-based palliative care with patients with limited health literacy (LHL) poses particular demands on communication. In this context, patients' emotions and vulnerable condition impact their skills to obtain, understand, process and apply information about health and healthcare even more. If healthcare providers (HCPs) meet these demands, it could enhance communication. In this study, HCPs were interviewed and asked for their strategies, barriers and suggestions for improvement regarding communication and SDM with LHL patients in hospital-based palliative care. METHODS: A qualitative interview study was conducted in 2018 in four Dutch hospitals with 17 HCPs-11 physicians and 6 nurses. Transcripts were analyzed using thematic analysis. RESULTS: In general HCPs recognized limited literacy as a concept, however, they did not recognize limited health literacy. Regarding SDM some HCPs were strong advocates, others did not believe in SDM as a concept and perceived it as unfeasible. Furthermore, five themes, acting as either strategies, barriers or suggestions for improvement emerged from the interviews: 1) time management; 2) HCPs' communication skills; 3) information tailoring; 4) characteristics of patients and significant others; 5) the content of the medical information. CONCLUSIONS: According to HCPs, more time to communicate with their patients could resolve the most prominent barriers emerged from this study. Further research should investigate the organizational possibilities for this and the actual effectiveness of additional time on effective communication and SDM. Additionally, more awareness for the concept of LHL is needed as a precondition for recognizing LHL. Furthermore, future research should be directed towards opportunities for tailoring communication, and the extent to which limited knowledge and complex information affect communication and SDM. This study provides first insights into perspectives of HCPs, indicating directions for research on communication, SDM and LHL in hospital-based palliative care.


Assuntos
Tomada de Decisão Clínica/métodos , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde/métodos , Cuidados Paliativos/psicologia , Feminino , Letramento em Saúde/normas , Humanos , Masculino , Relações Enfermeiro-Paciente , Enfermeiras e Enfermeiros/psicologia , Cuidados Paliativos/métodos , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/normas , Relações Médico-Paciente , Médicos/psicologia , Melhoria de Qualidade
19.
Hastings Cent Rep ; 50(3): 12-13, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596884

RESUMO

In a field that strives to care for patients and families together, what can palliative care clinicians do when patients' families are physically absent? The Covid-19 pandemic has put both literal and figurative walls between health care professionals and families. How health care workers respond to these disconnections might have a lasting impact on patients, on families, and on our practice. Recently, I saw this in the case of a patient our palliative care team was consulted to see. Mr. B was minimally responsive and dying from multisystem organ failure of unclear etiology. As in other cases during this pandemic, our team became a facilitator of interaction between the patient and the physically absent family, seeing an intimacy we normally would not, in this case, by being present while our intern held the phone to Mr. B's ear for an end-of-life call from his wife, son, and daughter. Such moments force us clinicians to be even more present for our families and patients, and they allow us to bear witness to the strength and sadness and love that we might otherwise miss.


Assuntos
Infecções por Coronavirus/epidemiologia , Família/psicologia , Cuidados Paliativos/organização & administração , Cuidados Paliativos/psicologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Consultoria Ética , Humanos , Pandemias
20.
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
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