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1.
Medicine (Baltimore) ; 100(14): e25397, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832133

RESUMO

ABSTRACT: Decision-making to stop cancer treatment in patients with advanced cancer is stressful, and it significantly influences subsequent end-of-life palliative treatment. However, little is known about the extent to which the patient's self-decisions influenced the prognostic period. This study focused on the patient's self-decision and investigated the impact of the self-decision to stop cancer treatment on their post-cancer treatment survival period and place of death.We retrospectively analyzed 167 cases of advanced genitourinary cancer patients (kidney cancer: 42; bladder cancer: 68; prostate cancer: 57) treated at the University of Fukui Hospital (UFH), who later died because of cancer. Of these, 100 patients decided to stop cancer treatment by themselves (self-decision group), while the families of the remaining 67 patients (family's decision group) decided to stop treatment on their behalf because the patient's decision-making ability was already impaired. Differences in the post-cancer-treatment survival period and place of death between the 2 groups were examined. The association between place of death and survival period was also analyzed.The median survival period after terminating cancer treatment was approximately 6 times longer in the self-decision group (145.5 days in self-decision group vs 23.0 days in family's decision group, P < .001). Proportions for places of death were as follows: among the self-decision group, 42.0% of patients died at UFH, 45.0% at other medical institutions, and 13.0% at home; among the family's decision group, 62.7% died at UFH, 32.8% at other medical institutions, and 4.5% at home. The proportion of patients who died at UFH was significantly higher among the family's decision group (P = .011). The median survival period was significantly shorter for patients who died at UFH (UFH: 30.0 days; other institutions/home: 161.0 days; P < .001).Significantly longer post-cancer-treatment survival period and higher home death rate were observed among patients whose cancer treatment was terminated based on their self-decision. Our results provide clinical evidence, especially in terms of prognostic period and place of death that support the importance of discussing bad news, such as stopping cancer treatment with patients.


Assuntos
Família/psicologia , Doente Terminal/psicologia , Neoplasias Urogenitais/mortalidade , Neoplasias Urogenitais/terapia , Suspensão de Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Morte , Estudos de Casos e Controles , Tomada de Decisões/fisiologia , Feminino , Humanos , Japão/epidemiologia , Neoplasias Renais/epidemiologia , Neoplasias Renais/mortalidade , Neoplasias Renais/psicologia , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Prognóstico , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/psicologia , Neoplasias da Próstata/terapia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Assistência Terminal/ética , Assistência Terminal/psicologia , Neoplasias da Bexiga Urinária/epidemiologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/psicologia , Neoplasias da Bexiga Urinária/terapia , Neoplasias Urogenitais/patologia , Neoplasias Urogenitais/psicologia
2.
BMJ Open ; 11(4): e038914, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849845

RESUMO

OBJECTIVES: With 'eating' posited as Singapore's domestic pastime, food experiences for Singaporeans constitute national, social, ethnic and personal identities. However, though they form significant parts of Singaporean existence across the lifespan, studies and observations about food experiences for individuals at the end of life remain noticeably absent. Extant literature continues to focus on nutritional practice during illness and the active dying process, forgoing the rich lived experiences of food in the lives of patients and their families. The current work sought to qualitatively extricate through a constructivist phenomenological approach, the 'food voices' of Singaporean palliative care patients and their families. It also simultaneously aimed to assess the role of food in bolstering their subjective feelings of dignity and identity, while also considering resultant clinical implications. SETTING: Homes of patients within the Singaporean palliative care setting. PARTICIPANTS: A subset of qualitative data (n=25) in the form of dyadic interviews with terminally ill patients and a family caregiver was generated from a larger family dignity intervention study that explored the experience of living and dying among Asian palliative care patients and their families. RESULTS: Framework analysis with both inductive and deductive approaches informed by the a priori domain of food resulted in the generation of four major themes, each with three subthemes. These were organised into the Food for Life and Palliation model. They include: (1) feeding identity and familial bonds, (2) liminal subsistence in illness transition, (3) food becoming lineage, and (4) compassionate nourishment. CONCLUSIONS: Clinical implications are considered; including food-focused interventions that enhance dignity, promote meaning-making and facilitate legacy construction. Developmental suggestions are also directed at industry partners producing end-of-life nutrition products.


Assuntos
Cuidados Paliativos , Assistência Terminal , Ásia , Humanos , Poder Psicológico , Pesquisa Qualitativa , Respeito , Doente Terminal
4.
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
5.
Rev. urug. enferm ; 16(1): 1-13, mar. 2021.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1150996

RESUMO

Objetivo: descrever as barreiras vivenciadas e as estratégias ao seu enfrentamento utilizadas por profissionais de enfermagem para realizar o cuidado a pacientes em final de vida em um serviço de urgência e emergência. Materiais e Métodos: Trata-se de uma pesquisa descritiva, exploratória, de abordagem qualitativa, conduzida em um serviço de urgência e emergência no sul do Brasil, com um enfermeiro e dois técnicos por turno, totalizando 12 profissionais de enfermagem. Os dados foram produzidos entre maio e junho de 2018, por meio de entrevista semiestruturada e observação simples e, posteriormente, organizados por aproximação temática no programa Ethnograph v6, em sua versão de demonstração e submetidos à análise de conteúdos proposta por Laurence Bardin. Resultados: Foram elaboradas duas categorias: Barreiras aos cuidados às pessoas em final de vida e Estratégias para o enfrentamento das barreiras ao cuidado no final da vida. Os profissionais de enfermagem referiram que, embora o cenário do serviço de urgência e emergência seja adverso devido a fatores limitantes como rotina acelerada, por exemplo, buscam compreender e atender às necessidades dos pacientes dentro dos limites estruturais, de recursos humanos e institucionais. Assim, são realizados cuidados visando o alívio da dor e promoção de seu conforto. Conclusão: evidenciou-se conflito entre o idealizado e o realizado, pois os profissionais elencam aquilo que consideram prioridade para o cuidado no final da vida, mas nem sempre conseguem implementálo. Quando o fim da vida ocorre nos serviços de saúde é necessário movimentos de desconstrução das práticas atuais ofertadas, especialmente nos serviços de urgência e emergência.


Objetivo: describir las barreras experimentadas y las estrategias al su enfrentamiento utilizadas por los profesionales de enfermería para hacer el cuidado a los pacientes al final de la vida en un servicio de urgencia. Materiales y Métodos: investigación con enfoque cualitativo conducida en un servicio de urgencia y emergencia en el sur de Brasil con 12 profesionales de enfermería. Los datos fueron colectados entre mayo y junio de 2018 a través de entrevista semiestructurada y, luego, organizados en el programa Ethnograph, en su versión de demostración, y sometidos al análisis de contenido según Laurence Bardin. Resultados: fueron establecidas dos categorías: Barreras a los cuidados a las personas al final de la vida y Estrategias al enfrentamiento de las barreras al cuidado al final de la vida. Los profesionales de enfermería reportaron que, aunque el servicio de urgencia sea adverso debido a factores limitantes como rutina acelerada, por ejemplo, buscan comprender y atender a las necesidades de los pacientes dentro de los límites estructurales, de recursos humanos e institucionales. De esta forma realizan cuidados visando el alivio del dolor y la promoción de su confort. Conclusión: se concluye que existe confl icto entre lo idealizado y lo realizado puesto que los profesionales eligen aquello que consideran prioridad al cuidado en el final de la vida, si bien ni siempre logran implementarlo. Cuando el fin de la vida ocurre en los servicios de salud es necesario movimientos de desconstrucción de las prácticas actuales ofrecidas, especialmente en los servicios de urgencia.


Objective: to describe the barriers found and the strategies utilized by nursing professionals to face them to perform the care to end-of-life patients in an emergency medical service. Materials and Methods: we conducted a descriptive, exploratory, qualitative approach, in an emergency service in the south of Brazil, with 12 nursing professionals. We produced the data between May and June of 2018, through a semistructured interview and simple observation and, later, organized by the thematic approach in the program Ethnograph v6, in its version of demonstration and submitted to the content analysis proposed by Laurence Bardin. Results: we elaborated two categories: Barriers to care for people in the end-of-life and Strategies for coping with barriers to care at the end of life. Nursing professionals reported that, although the emergency service is adverse due to limiting factors such as an accelerated routine, for example, they seek to understand and meet patients' needs within the structural, human and institutional limits. Thus, care is taken to relieve pain and promote comfort. Conclusion: there was a conflict between the idealized and the realized, because the professionals list what they consider a priority for care at the end of life, but they are not always able to implement it. When the end of life occurs in health services, it is necessary to deconstruct the current practices offered, especially in emergency services.


Assuntos
Humanos , Planejamento de Assistência ao Paciente , Assistência Terminal , Brasil , Enfermagem , Cuidados Paliativos na Terminalidade da Vida , Estado Terminal , Doente Terminal , Serviços Médicos de Emergência , Recursos em Saúde , Recursos Humanos de Enfermagem no Hospital
6.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 15-20, 2021 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-33663656

RESUMO

Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.


Assuntos
Gastos em Saúde , Doente Terminal , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Hospitalização , Humanos , Pacientes Internados , Masculino
7.
BMC Cancer ; 21(1): 304, 2021 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-33757453

RESUMO

BACKGROUND: The clinical use of patient-reported outcomes as compared to inflammatory biomarkers for predicting cancer survival remains a challenge in palliative care settings. We evaluated the role of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative scores (EORTC QLQ-C15-PAL) and the inflammatory biomarkers C-reactive protein (CRP), albumin (Alb), and neutrophil-lymphocyte ratio (NLR) for survival prediction in patients with advanced cancer. METHODS: This was an observational study in terminally ill patients with cancer hospitalized in a palliative care unit between June 2018 and December 2019. Patients' data collected at the time of hospitalization were analyzed. Cox regression was performed to examine significant factors influencing survival. A receiver operating characteristic (ROC) analysis was performed to estimate cut-off values for predicting survival within 3 weeks, and a log-rank test was performed to compare survival curves between groups divided by the cut-off values. RESULTS: Totally, 130 patients participated in the study. Cox regression suggested that the QLQ-C15-PAL dyspnea and fatigue scores and levels of CRP, Alb, and NLR were significantly associated with survival time, and cut-off values were 66.67, 66.67, 3.0 mg/dL, 2.5 g/dL, and 8.2, respectively. The areas under ROC curves of these variables were 0.6-0.7. There were statistically significant differences in the survival curves between groups categorized using each of these cut-off values (p < .05 for all cases). CONCLUSION: Our findings suggest that the assessment of not only objective indicators for the systemic inflammatory response but also patient-reported outcomes using EORTC QLQ-C15-PAL is beneficial for the prediction of short-term survival in terminally ill patients with cancer.


Assuntos
Proteína C-Reativa/análise , Neoplasias/mortalidade , Qualidade de Vida , Inquéritos e Questionários , Doente Terminal , Humanos , Linfócitos , Neoplasias/imunologia , Neoplasias/psicologia , Neutrófilos , Modelos de Riscos Proporcionais , Estudos Prospectivos , Albumina Sérica/análise
8.
Artigo em Inglês | MEDLINE | ID: mdl-33573116

RESUMO

This study aimed to expand on previous research elucidating the effects of dispositional resilience and self-efficacy on practice in advanced care planning (ACP) of terminally ill patients among Taiwanese nurses using path modeling. This cross-sectional study was conducted using cluster sampling. Data were collected using demographics, nurses' knowledge, attitude, and practice of ACP (KAP-ACP) inventory, Dispositional Resilience Scale, and General Self-Efficacy Scale. A total of 266 nurses from a tertiary medical center in northern Taiwan participated in this study in 2019. The results showed that gender and ward were significant K-ACP predictors among nurses. The ACP knowledge, ward, and experience of caring for terminally ill friends or relatives were significant A-ACP predictors, whereas ACP attitudes, dispositional resilience, self-efficacy, ward, and the frequency of caring for terminally ill patients were the key predictors of P-ACP. The path modeling showed that dispositional resilience; self-efficacy; medical, surgical, hematology and oncology wards; previous experience in caring for terminally ill friends or relatives; participating in the do-not-resuscitate signature; and the frequency of caring for terminally ill patients directly influenced ACP practices. We recommend that nurses enhance their dispositional resilience and self-efficacy, which may encourage them to appreciate the value of ACP practice of terminally ill patients and improve the quality of care.


Assuntos
Autoeficácia , Doente Terminal , Atitude do Pessoal de Saúde , Estudos Transversais , Humanos , Taiwan
9.
Int J Palliat Nurs ; 27(1): 46-52, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33629907

RESUMO

BACKGROUND: Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS: To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS: An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS: Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS: Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.


Assuntos
Desidratação/complicações , Neoplasias Gástricas/complicações , Doente Terminal , Desequilíbrio Hidroeletrolítico/complicações , Analgésicos Opioides/uso terapêutico , Glicemia/análise , Caquexia/complicações , Constipação Intestinal/complicações , Desidratação/etiologia , Delusões/complicações , Uso de Medicamentos , Dispneia/complicações , Feminino , Glucocorticoides/uso terapêutico , Alucinações/complicações , Hemoglobinas/análise , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/complicações , Prognóstico , Estudos Retrospectivos , Albumina Sérica/análise , Sódio/sangue , Neoplasias Gástricas/mortalidade , Vômito/complicações , Desequilíbrio Hidroeletrolítico/etiologia
10.
Int J Palliat Nurs ; 27(1): 10-19, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33629914

RESUMO

BACKGROUND: Children with life-limiting conditions have a high risk of colonisation with a multidrug-resistant organism (MDRO). To avoid the spread of hospital-aquired infections to other patients, children with a MDRO are moved to an isolated room or ward. However, such isolation prevents social participation, which may reduce the child's quality of life (QoL). To overcome this challenge of conflicting interests on a paediatric palliative care inpatient unit, a hygiene concept for patients colonised with MDRO, called PALLINI, was implemented. PALLINI advises that, instead of isolating the affected children, strict barrier nursing should be used. AIM: To identify the impact of a complex hygiene concept on children's and parents' QoL and social participation. METHODS: Cross-sectional mixed-methods research approach, comprising semi-structured interviews with parents and staff members, and a QoL-questionnaire focusing on the child which was completed by parents. FINDINGS: In paediatric patients with life-limiting conditions who have MDRO colonisation, using a complex hygiene protocol resulted in both benefits and barriers to social participation. However, the child's QoL did not appear to be affected. CONCLUSION: All staff members and families have to be familiar with the hygiene concept and the concept has to be self-explanatory and easy to apply.


Assuntos
Resistência a Múltiplos Medicamentos , Controle de Infecções/organização & administração , Qualidade de Vida , Participação Social , Doente Terminal , Criança , Pré-Escolar , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Feminino , Unidades Hospitalares , Humanos , Lactente , Capacitação em Serviço , Entrevistas como Assunto , Masculino , Avaliação em Enfermagem , Cuidados Paliativos , Pais , Isolamento de Pacientes , Segurança do Paciente , Estereotipagem , Inquéritos e Questionários
11.
BMC Palliat Care ; 20(1): 8, 2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33422058

RESUMO

BACKGROUND: Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. METHODS: This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. RESULTS: Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. CONCLUSIONS: The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.


Assuntos
Infecções por HIV/fisiopatologia , Determinação de Necessidades de Cuidados de Saúde , Neoplasias/fisiopatologia , Cuidados Paliativos , Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Tuberculose Resistente a Múltiplos Medicamentos/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoal Técnico de Saúde , Butão , Cognição , Feminino , Estado Funcional , Infecções por HIV/psicologia , Infecções por HIV/terapia , Humanos , Hepatopatias Alcoólicas/fisiopatologia , Hepatopatias Alcoólicas/psicologia , Hepatopatias Alcoólicas/terapia , Pneumopatias/fisiopatologia , Pneumopatias/psicologia , Pneumopatias/terapia , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Neoplasias/terapia , Enfermeiras e Enfermeiros , Médicos , Funcionamento Psicossocial , Insuficiência Renal Crônica/psicologia , Insuficiência Renal Crônica/terapia , Interação Social , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/terapia , Doente Terminal , Tuberculose Resistente a Múltiplos Medicamentos/psicologia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Adulto Jovem
12.
BMC Palliat Care ; 20(1): 13, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435925

RESUMO

BACKGROUND: Artificial nutrition and hydration do not prolong survival or improve clinical symptoms of terminally ill cancer patients. Nonetheless, little is known about the effect of artificial hydration (AH) alone on patients' survival, symptoms or quality of dying. This study explored the relationship between AH and survival, symptoms and quality of dying among terminally ill cancer patients. METHODS: A pilot prospective, observational study was conducted in the palliative care units of three tertiary hospitals in Taiwan between October 2016 and December 2017. A total of 100 patients were included and classified into the hydration and non-hydration group using 400 mL of fluid per day as the cut-off point. The quality of dying was measured by the Good Death Scale (GDS). Multivariate analyses using Cox's proportional hazards model were used to assess the survival status of patients, the Wilcoxon rank-sum test for within-group analyses and the Mann-Whitney U test for between-groups analyses to evaluate changes in symptoms between day 0 and 7 in both groups. Logistic regression analysis was used to assess the predictors of a good death. RESULTS: There were no differences in survival (p = 0.337) or symptom improvement between the hydration and non-hydration group, however, patients with AH had higher GDS scores. CONCLUSIONS: AH did not prolong survival nor significantly improve dehydration symptoms of terminally ill cancer patients but it may influence the quality of dying. Communication with patients and their families on the effect of AH may help them better prepared for the end-of-life experience.


Assuntos
Desidratação/terapia , Hidratação , Neoplasias/terapia , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Projetos Piloto , Modelos de Riscos Proporcionais , Estudos Prospectivos , Taxa de Sobrevida , Doente Terminal
13.
J Int Med Res ; 49(1): 300060520987726, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33478318

RESUMO

OBJECTIVES: To determine the prevalence of neuropathic pain among terminally ill patients with cancer admitted to a general ward, using the International Association for the Study of Pain algorithm. METHODS: This prospective observational study was conducted at a tertiary care center. We enrolled terminally ill patients with cancer admitted to the general ward between September 2018 and September 2019. On the day of consultation with our palliative care team, pain management clinicians examined and diagnosed neuropathic pain using the International Association for the Study of Pain diagnostic criteria. RESULTS: A total of 108 patients were enrolled during the study period. The median age was 69 years (interquartile range [IQR] 58.3-76.8 years), 72 patients (66.7%) were men, and the median survival time was 33 days (IQR 14.3-62 days). Of the 108 patients, 33 (30.6%) had neuropathic pain. Patients with neuropathic pain had more severe pain than those without neuropathic pain. CONCLUSIONS: The prevalence of neuropathic pain in terminally ill patients with cancer admitted to a Japanese general ward was 30.6%. Further studies are warranted to elucidate whether the accurate diagnosis of neuropathic pain can improve pain control and/or patient conditions.


Assuntos
Neoplasias , Neuralgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Neuralgia/diagnóstico , Neuralgia/epidemiologia , Cuidados Paliativos , Quartos de Pacientes , Prevalência , Doente Terminal
14.
Support Care Cancer ; 29(1): 525-531, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32415383

RESUMO

PURPOSE: Our study aimed to evaluate the association between CDS and survival time using the likelihood of receiving CDS to select a matched non-CDS group through an accurate measurement of survival time based on initiation of CDS. METHODS: A retrospective cohort study was performed using an electronic database to collect data regarding terminally ill cancer patients admitted to a specialized palliative care unit from January 2012 to December 2016. We first used a Cox proportional hazard model with receiving CDS as the outcome to identify individuals with the highest plausibility of receiving CDS among the non-CDS group (n = 663). We then performed a multiple regression analysis comparing the CDS group (n = 311) and weighted non-CDS group (n = 311), using initiation of CDS (actual for the CDS group; estimated for the non-CDS group) as the starting time-point for measuring survival time. RESULTS: Approximately 32% of participants received CDS. The most common indications were delirium or agitation (58.2%), intractable pain (28.9%), and dyspnea (10.6%). Final multiple regression analysis revealed that survival time was longer in the CDS group than in the non-CDS group (Exp(ß), 1.41; P < 0.001). Longer survival with CDS was more prominent in females, patients with renal dysfunction, and individuals with low C-reactive protein (CRP) or ferritin, compared with their counterpart subgroup. CONCLUSIONS: CDS was not associated with shortened survival; instead, it was associated with longer survival in our terminally ill cancer patients. Further studies in other populations are required to confirm or refute these findings.


Assuntos
Sedação Profunda/efeitos adversos , Hipnóticos e Sedativos/efeitos adversos , Neoplasias/mortalidade , Cuidados Paliativos/métodos , Doente Terminal/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos
15.
Rev. enferm. UERJ ; 28: e49853, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1146273

RESUMO

Objetivo: compreender a vivência da espiritualidade de idosos em cuidados paliativos de um hospital público de Belo Horizonte. Método: trata-se de uma pesquisa qualitativa com 11 idosos em cuidados paliativos, por meio uma entrevista a partir de três questões norteadoras. Para análise dos dados, foram aplicadas as três etapas previstas no processo de análise de conteúdo. Resultados: emergiram duas categorias, "A espiritualidade no idoso em cuidados paliativos" e "A percepção do idoso sobre a abordagem da espiritualidade pela equipe de saúde". Conclusão: os idosos em cuidados paliativos vivenciam a espiritualidade, as relações com o transcendente, independentemente de possuir uma religião. E buscam adaptações às novas condições de vida, dando alívio dos sintomas por meio da relação com o sagrado.


Objective: to understand the experience of spirituality in older adults in palliative care at a public hospital in Belo Horizonte. Method: this qualitative study of 11 older adults in palliative care was conducted by interview based on three guiding questions. Data were processed by three-step content analysis. Results: two categories emerged, "Spirituality in older adults in palliative care" and "Older adults' perceptions of the health team's approach to spirituality". Conclusion: the older adults in palliative care experienced spirituality, relationships with transcendence, regardless of whether or not they had a religion. They endeavor to adapt to the new conditions of life and relieve their symptoms through relationships with things sacred.


Objetivo: comprender la experiencia de la espiritualidad en adultos mayores en cuidados paliativos en un hospital público de Belo Horizonte. Método: este estudio cualitativo de 11 adultos mayores en cuidados paliativos se realizó mediante entrevista basada en tres preguntas orientadoras. Los datos se procesaron mediante análisis de contenido de tres pasos. Resultados: surgieron dos categorías, "Espiritualidad en adultos mayores en cuidados paliativos" y "Percepciones de los adultos mayores sobre el enfoque de espiritualidad del equipo de salud". Conclusión: los adultos mayores en cuidados paliativos experimentaron espiritualidad, relaciones con trascendencia, independientemente de si tenían religión o no. Se esfuerzan por adaptarse a las nuevas condiciones de vida y aliviar sus síntomas mediante relaciones con cosas sagradas.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Cuidados Paliativos , Cuidados Paliativos na Terminalidade da Vida , Doente Terminal , Espiritualidade , Hospitais Públicos , Equipe de Assistência ao Paciente , Percepção , Brasil , Pesquisa Qualitativa
16.
Rev. bioét. (Impr.) ; 28(4): 604-609, out.-dez. 2020.
Artigo em Português | LILACS | ID: biblio-1155749

RESUMO

Resumo O objetivo deste estudo é refletir sobre as características e finalidades do documento de diretivas antecipadas de vontade do paciente. Conclui-se que tal documento deve ter formato único, que reflita a generalidade dos termos da Resolução 1.805/2006 do Conselho Federal de Medicina, e que sua principal finalidade é fortalecer a sensação de segurança jurídica do profissional médico. Por fim, destaca-se que, ainda que se considerem as determinações escritas, prevalecerá o entendimento entre paciente e equipe.


Abstract This study aimed to reflect on the characteristics and objectives of the patient's advance directives. This document should have a standard format, including the general terms of Resolution 1.805/2006 of the Federal Council of Medicine, and strengthen the sense of legal certainty of health professionals. Even with written determinations, the understanding between patient and staff shall prevail.


Resumen El objetivo de este estudio es hacer consideraciones sobre las características y propósitos del documento relativo a las directivas anticipadas de voluntad del paciente. Se concluye que debe tener un formato único, que refleje los términos generales de la Resolución 1.805/2006 del Consejo Federal de Medicina, y que su principal propósito es fortalecer la percepción de seguridad jurídica del profesional médico. Finalmente, se enfatiza que, incluso si se consideran las determinaciones escritas, prevalecerá el entendimiento entre el paciente y el equipo.


Assuntos
Humanos , Masculino , Feminino , Bioética , Diretivas Antecipadas , Direitos Civis , Doente Terminal
18.
J Med Life ; 13(3): 321-328, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072203

RESUMO

Dental health plays an imperative role in the general health and well-being of an individual. Terminally ill patients due to a compromised immune response are susceptible to a wide array of oral complications, which may affect their ability to speak and chew, leading to malnutrition. The present study was conducted to evaluate dental health and various oral manifestations in terminally ill patients. One hundred twenty terminally ill patients hospitalized with diseases of the respiratory tract, gastrointestinal tract, circulatory system, liver, and endocrinal disorders were included in the study. The evaluation of oral manifestations and their prevalence was done by a single examiner. The oral health was evaluated according to symptoms exhibited by the patients and clinical presentation. Of the patients included in the study, 78 were male, and 42 were female. All the individuals were adults between 25 to 55 years of age. Out of 120 admitted terminally ill patients, 27 subjects had respiratory diseases, 17 had gastrointestinal disorders, 5 had disorders of the circulatory system, 39 had liver disorders, and 32 had endocrine disorders. A need for added comprehension is mandatory to link the inter-relationships between dentistry and medicine to further perk up the management of the overall health of patients, which will further reinforce the partnership between dental and medical communities.


Assuntos
Saúde Bucal , Doente Terminal , Adulto , Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Artigo em Inglês | MEDLINE | ID: mdl-32927824

RESUMO

Life-sustaining treatments (LSTs) and end-of-life (EOL) care's goal for prolonging one's life are defined as aggressive EOL care among critically ill patients. They have limited effects and add unnecessary financial burden to advanced cancer patients. A questionnaire survey was conducted to collect information on demographics, disease conditions, preference for LSTs, and goal of EOL care among advanced cancer patients of comprehensive grade-A tertiary hospitals in Wuhan, mainland China. Most patients preferred to accept LSTs when they were in a critical condition, including cardiopulmonary resuscitation (89.9%), mechanical ventilation support (85.7%), nasogastric tube feeding (84.1%), blood transfusion (89.8%), general surgery (87.5%), and hemodialysis (85.8%). Most (88%) preferred prolonging life as the goal of EOL care. Logistic regression showed common influencing factors were participants who completed junior high/high school or below and were financially adequate had higher reference for aggressive EOL care. Patients whose physician had accurately disclosed prognosis; however, showed a decrease trend for aggressive EOL care. Most advanced cancer patients preferred to accept aggressive EOL care. Discussions about prognosis disclosure among physicians and patients should be improved. Education about LSTs' limitations and comfort-oriented care's benefits should be promoted among the advanced cancer patients in mainland China.


Assuntos
Cuidados para Prolongar a Vida/métodos , Neoplasias/epidemiologia , Preferência do Paciente , Assistência Terminal/métodos , Doente Terminal/psicologia , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Neoplasias/terapia
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