Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.252
Filtrar
3.
Medicine (Baltimore) ; 100(32): e26915, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397931

RESUMO

ABSTRACT: The hospice and palliative care can improve the symptoms and signs of terminal cancer patients. The purposes of this study are how to improve terminally ill cancer patients' symptoms and signs and how the dedicated palliative care service effects on these improvements.From January 2017 to March 2019, among 919 terminally ill cancer patients admitted to the palliative care units in 11 hospitals of South Korea, we analyzed 334 patients with prospective cohort method and categorized them into non-dedicated hospice care group of 234 and dedicated hospice care group of 100.Symptoms improvement of dyspnea, fatigue, drowsiness, and dry mouth during the first week of admission were respectively 298 (89.2%), 25 (7.5%), 204 (61.1%), 76 (22.8%). Signs improvement of myoclonus, respiratory secretion, leg edema, and ascites between admission and a week after were 5 (1.5%), 41 (12.3%), 47 (14.1%), 12 (3.6%). Significant differences between dedicated hospice care physician group and non-dedicated hospice care physician group were shown in drowsiness (67.5% vs 46%, P < .001) and respiratory secretion (15% vs 6%, P < .028). Compared to non-dedicated care group, the odds ratio for more than 2 symptoms or signs was 1.78 (95% confidence interval, 1.05-3.02) in the dedicated care group after adjusting confounding variables.In conclusion, terminally ill cancer patients who received palliative or hospice service showed significant improvement in symptoms and signs. And, family doctors (dedicated hospice physician group) performed better than oncologists (non-dedicated physician group).


Assuntos
Cuidados Paliativos na Terminalidade da Vida/métodos , Neoplasias/terapia , Médicos/psicologia , Doente Terminal/psicologia , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Neoplasias/epidemiologia , Neoplasias/psicologia , Estudos Prospectivos , República da Coreia/epidemiologia
4.
Am J Nurs ; 121(6): 11, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34009145

RESUMO

It may be hard for a nurse to accept what the patient wants, but it's essential.


Assuntos
Morte , Tomada de Decisões , Relações Enfermeiro-Paciente , Participação do Paciente/psicologia , Assistência Terminal/psicologia , Doente Terminal/psicologia , Atitude Frente a Morte , Humanos
5.
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
6.
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
7.
Support Care Cancer ; 29(5): 2743-2748, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32989524

RESUMO

PURPOSE: The aim of the study was to determine the diagnostic accuracy of patient-reported dry mouth using an oral moisture-checking device in terminally ill cancer patients. METHODS: The study was conducted following the STARD guidelines, and the participants were recruited prospectively from the Palliative Care Unit, Kyoto Medical Center, Japan, between 1 January 2017 and 30 November 2018. Patients reporting dry mouth were asked to rate oral dryness on a 5-point rating scale. The outcome was oral dryness at the lingual mucosa, measured using an oral moisture-checking device. Receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR), and overall diagnostic accuracy were calculated. RESULTS: Of 103 participants, the prevalence of oral dryness was 65.0%. ROC analysis indicated that patient-reported dry mouth was a poor predictor of oral dryness, with an area under the curve of 0.616 (95% confidence interval: 0.508-0.723), a sensitivity of 46.3%, a specificity of 75.8%, a PPV of 55.9%, an NPV of 68.1, a positive LR of 1.9, a negative LR of 0.7, and an overall diagnostic accuracy of 64.1%, with a cut-off value of 3 points. CONCLUSION: In conclusion, patient-reported dry mouth is not a useful parameter for the assessment of oral dryness in terminally ill cancer patients.


Assuntos
Neoplasias/complicações , Medidas de Resultados Relatados pelo Paciente , Doente Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Xerostomia/diagnóstico
8.
Support Care Cancer ; 29(5): 2795-2802, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32996000

RESUMO

PURPOSE: Spiritual well-being is very important in patients undergoing palliative care. Although psychosocial factors have been suggested to be associated with spiritual well-being, the relationship between physical signs and spiritual well-being has not been fully elucidated. The aim of this study was to explore diverse factors associated with spiritual well-being among palliative care patients in Japan. METHODS: This study is a secondary analysis of a multicenter prospective cohort study involving patients admitted to palliative care units in Japan. Physicians recorded all data prospectively on a structured sheet designed for the study. The spiritual well-being score was measured using the Integrated Palliative Outcome Scale after patients' death in regard to symptoms over the previous 3 days. We classified each patient into "better" score (0-1) and "worse" score (2-4) groups and examined diverse factors associated with spiritual well-being. RESULTS: Among the 1896 patients enrolled, 1313 were evaluated. In the multivariate analysis, seven variables were significantly associated with "worse" score: worse spiritual well-being on admission (2-4) (p < 0.0001), younger age (< 80) (p = 0.0001), hyperactive delirium over 3 days before death (mild/moderate/severe) (p = 0.0001), expressed wish for hastened death (yes) (p = 0.0006), worse communication among patients and families (Support Team Assessment Schedule score 2-4) (p = 0.0008), pleural effusion (present) (p = 0.037), and marital status (unmarried) (p = 0.0408). CONCLUSION: Recognizing factors associated with spiritual well-being is potentially useful for identifying high-risk groups with lower spiritual well-being at the end of life. Further study is required to investigate factors associated with patient-reported spiritual well-being.


Assuntos
Neoplasias/psicologia , Espiritualidade , Doente Terminal/psicologia , Idoso , Feminino , Humanos , Pacientes Internados , Japão , Masculino , Estudos Prospectivos
9.
Palliat Support Care ; 19(1): 119-121, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32856581

RESUMO

BACKGROUND: End-of-life is a unique and multidimensional experience, and physical complaints can reveal other areas of distress. METHOD: A case report of a woman with terminal cancer with painful and deforming skin striae cared by a multidisciplinary team. RESULTS: After initially treating her physical pain, other end-of-life psychosocial, spiritual, and existential aspects could be addressed. SIGNIFICANCE OF RESULTS: Physical distress can unveil other essential areas of end-of-life experience when multidisciplinary teams caring for the terminally ill patients use holistic approaches.


Assuntos
Neoplasias , Assistência Terminal , Doente Terminal , Dor do Câncer , Existencialismo , Feminino , Humanos , Neoplasias/patologia , Neoplasias/psicologia , Neoplasias/terapia , Cuidados Paliativos , Dermatopatias/patologia , Dermatopatias/psicologia , Dermatopatias/terapia , Doente Terminal/psicologia
10.
Nurs Health Sci ; 23(1): 167-175, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33169901

RESUMO

Professional values reflect nurses' understanding of how to deliver professional care, which might influence nurses' attitudes and caring behaviors during end-of-life care. However, limited research has been conducted to explore nurses' experiences of professional development during end-of-life care, and theoretical explanations are scarce about how nurses enact their professional values during the caring process. This study explored the social process of professional values involved in end-of-life care in the Chinese cultural context by adopting a constructivist grounded theory approach. Twenty semi-structured in-depth interviews with 15 nurses from three hospitals in southeastern China were conducted. A theoretical framework emerged when focusing on the social process of "reframing the meaning of life and professional values" to facilitate professional care for terminally ill patients. Three main categories were sequentially identified as "recognizing the dilemmas when caring for terminally ill patients," "applying strategies to deal with values conflict," and "reconstructing values." This theoretical framework may be applied as a practical framework for equipping nurses with effective strategies to cultivate professional values, including the provision of adequate end-of-life knowledge, and a supportive workplace environment.


Assuntos
Assistência à Saúde Culturalmente Competente , Assistência Terminal/métodos , Doente Terminal/psicologia , Teoria Fundamentada , Hospitais , Humanos , Entrevistas como Assunto , Modelos Teóricos , Pacientes , Pesquisa Qualitativa , Assistência Terminal/ética
11.
Cancer Nurs ; 44(3): 214-222, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649334

RESUMO

BACKGROUND: Home is often deemed to be the preferred place of death for most patients. Knowing the factors related to the actualization of a preferred home death may yield evidence to enhance the organization and delivery of healthcare services. OBJECTIVE: The objectives of this study were to measure the congruence between a preferred and actualized home death among cancer patients in receipt of home-based palliative care in Canada and explore predictors of actualizing a preferred home death. METHODS: A longitudinal prospective cohort design was conducted. A total of 290 caregivers were interviewed biweekly over the course of patients' palliative care trajectory between July 2010 and August 2012. Cross-tabulations and multivariate analyses were used in the analysis. RESULTS: Home was the most preferred place of death, and 68% of patients who had voiced a preference for home death had their wish fulfilled. Care context variables, such as living with others and the intensity of home-based nursing visits and hours of care provided by personal support workers (PSW), contributed to actualizing a preferred home death. The intensity of emergency department visits was associated with a lower likelihood of achieving a preferred home death. CONCLUSIONS: Higher intensity of home-based nursing visits and hours of PSW care contribute to the actualization of a preferred home death. IMPLICATIONS FOR PRACTICE: This study has implications for policy decision-makers and healthcare managers. Improving and expanding the provision of home-based PSW and nursing services in palliative home care programs may help patients to actualize a preferred home death.


Assuntos
Tomada de Decisões , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Assistência Terminal/psicologia , Doente Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Canadá , Cuidadores , Estudos de Coortes , Serviços de Assistência Domiciliar/estatística & dados numéricos , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estudos Prospectivos
12.
Med. paliat ; 27(4): 2280-286, oct.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202708

RESUMO

INTRODUCCIÓN: Los cuidados paliativos pediátricos consisten en los cuidados activos e integrales que se realizan al cuerpo, mente y espíritu del niño y su familia, desde que es diagnosticado de una enfermedad amenazante para la vida. Las investigaciones se centran sobre los efectos que esto causa en los padres y los niños, sin centrarse en las repercusiones que esto tiene en los hermanos. OBJETIVO: Conocer y analizar las experiencias y necesidades de los hermanos de niños en situación paliativa desde la perspectiva de los profesionales más cercanos a ellos. MATERIALES Y MÉTODO: Estudio cualitativo exploratorio, que se centró en la provincia de Valencia. Participaron cinco profesionales que trabajan en la Asociación de Padres de Niños con Cáncer de la Comunidad Valenciana (ASPANION), y la obtención de datos se realizó mediante entrevistas individuales semiestructuradas. RESULTADOS: Aspectos referidos a la adaptación de la familia, los cambios de comportamiento de los hermanos durante el proceso, la comunicación entre ambos, la importancia de la información y la participación del hermano durante la enfermedad, así como las dificultades que encuentran los profesionales para tratar con estos hermanos, son algunos de los resultados obtenidos. CONCLUSIONES: Los hermanos viven los procesos paliativos con gran capacidad de adaptación, aunque, en momentos de estrés o cuando aparecen sentimientos de abandono o culpa, los hermanos lo expresan a través de cambios en el comportamiento. Es importante que los padres expresen sus miedos y mantengan el vínculo con el hermano, haciéndoles partícipes de la situación e informándoles de todo, teniendo muy en cuenta el factor de la edad. La gran demanda de los profesionales es la de poder trabajar con los hermanos directamente, de manera que puedan tener una atención más cercana


INTRODUCTION: Research on children in a palliative situation and the effects this exerts on parents is increasingly abundant. Despite this, there is still a gap in understanding the way in which siblings live through the stages of terminal illness and death. OBJECTIVE: To know and analyze the experiences and needs of the siblings of children in a palliative situation from the perspective of the professionals closest to them. MATERIAL AND METHOD: A qualitative exploratory study focused on the province of Valencia. Five professionals working for the Asociación de Padres de Niños con Cáncer de la Comundad Valenciana (ASPANION) participated, and the data collection was carried out using semi-structured individual interviews. RESULTS: Aspects related to family adaptation, behavior changes in siblings during the process, communication between family members, the importance of sibling information and participation during the illness period, and the difficulties professionals find in dealing with siblings are some of the results obtained. CONCLUSIONS: Siblings live palliative processes with great adaptability, although in times of stress, or when feelings of abandonment or guilt appear, they express their discomfort through changes in behavior. It is important that parents express their fears and maintain their bond with siblings, making them participants in the situation and informing them of everything, taking into account the age factor. The great demand by professionals is that they may work with siblings directly, so these may receive closer attention


Assuntos
Humanos , Masculino , Feminino , Criança , Criança Hospitalizada/psicologia , Irmãos/psicologia , Doente Terminal/psicologia , Cuidados Paliativos na Terminalidade da Vida/psicologia , Neoplasias/psicologia , Relações entre Irmãos , Atitude Frente a Morte , Resiliência Psicológica/classificação , Relações Familiares/psicologia , Pesquisa Qualitativa
13.
Eur J Oncol Nurs ; 49: 101828, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33070046

RESUMO

PURPOSE: Caregivers face severe difficulties in communicating openly with their terminally ill relatives about illness and death. Some studies suggest that females are more likely than males to hold such conversations. We compared level of open communication between male and female spouse-caregivers, and the contribution of personal and situational characteristics to the explanation of open communication level within each gender group. METHODS: The study design was correlational. We interviewed 77 spousal-primary caregivers of terminal cancer patients. Participants were recruited over a 10-month period from the home hospice unit of the central region of Israel's largest Health Maintenance Organization. The questionnaire included measures of open communication, along with caregiver's personal and situational characteristics. RESULTS: Female spouses reported higher levels of open communication about illness and death with their loved ones, compared to male spouses. Among males, duration of care and self-efficacy emerged as significant contributors to open communication level. Among females, self-efficacy and ethnic origin were found to be significant explanatory variables. CONCLUSIONS: This study demonstrates the important role gender plays in level of open communication between spousal caregivers and terminal cancer patients, concerning their illness and approaching death. Self-efficacy, ethnic origin and duration of care are also significant factors explaining open communication of both male and female caregivers. These factors should be considered by nurses and other healthcare professionals when developing intervention programs to increase the level of open communication between family caregivers and their terminally ill relatives.


Assuntos
Atitude Frente a Morte , Cuidadores/psicologia , Comunicação , Neoplasias/psicologia , Pacientes/psicologia , Cônjuges/psicologia , Doente Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários
14.
BMC Palliat Care ; 19(1): 160, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33059636

RESUMO

BACKGROUND: Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. METHODS: A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. RESULTS: Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family's preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient's preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. CONCLUSION: Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family's decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.


Assuntos
Atitude Frente a Morte , Neoplasias/mortalidade , Neoplasias/psicologia , Assistência Terminal/métodos , Assistência Terminal/psicologia , Doente Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inteligência Artificial , Interpretação Estatística de Dados , Mineração de Dados , Feminino , Serviços de Assistência Domiciliar , Hospitalização , Humanos , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Satisfação do Paciente , Probabilidade , Suíça/epidemiologia , Adulto Jovem
15.
Isr J Health Policy Res ; 9(1): 57, 2020 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-33106184

RESUMO

BACKGROUND: End-of-life decisions are highly complex socio-normative and ethical phenomena. The goal of this study was to provide an assessment of public opinions in Israel concerning aspects of end-of-life decisions. METHODS: An online cross sectional study was performed in February 2020. The primary tool including items pertaining to death assistance and truth telling to patients. A sample of 515 participants representative of the adult Israeli population was obtained. RESULTS: The majority of participants (71%) supports telling the entire truth to patients even in harsh conditions. Support for truth telling decreases with affiliation to religion, with as little as 40% support among ultra-orthodox. People with vocational education are the least supportive of truth telling. Concerning doctor assisted death, almost half (49%) of the sample were supportive. Opposition is positively associated with religiosity, with 90% of ultra-orthodox and 58% of religious participants opposing doctor-assisted death, compared to only 18% among seculars. Non-Jews were 3.35 times (95%CI: 1.90, 5.91) more likely to oppose doctor assisted death than Jews (p < .0001). An Interrelationship analysis crossing between attitudes revealed that the largest group (39%) was comprised of participants who support both ("autonomists"). CONCLUSIONS: Israelis are overwhelmingly supportive of truth telling to patients. In contrast, Israeli public opinions on doctor assisted death are divided. For both attitudes, religiousness plays a crucial role as a catalyst for conservatism and opposition to change. Almost a half of the public is also supportive of an autonomist approach that would allow patients to decide on ending their own lives.


Assuntos
Suicídio Assistido/psicologia , Assistência Terminal/psicologia , Doente Terminal/psicologia , Revelação da Verdade , Adolescente , Adulto , Idoso , Estudos Transversais , Tomada de Decisões , Feminino , Humanos , Israel , Judeus/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Papel do Médico , Opinião Pública , Religião , Adulto Jovem
16.
BMC Palliat Care ; 19(1): 154, 2020 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-33032574

RESUMO

BACKGROUND: End-of-life caregiving frequently is managed by friends and family. Studies on hastened death, including aid in dying or assisted suicide, indicate friends and family also play essential roles before, during, and after death. No studies have compared the experiences of caregivers in hastened and non-hastened death. The study aim is to compare end-of-life and hastened death caregiving experience using Hudson's modified stress-coping model for palliative caregiving. METHOD: Narrative synthesis of qualitative studies for caregivers at end of life and in hastened death, with 9946 end-of life and 1414 hastened death qualitative, peer-reviewed research articles extracted from MEDLINE, CINAHL, Web of Science, and PsycINFO, published between January 1998 and April 2020. RESULTS: Forty-two end-of-life caregiving and 12 hastened death caregiving articles met inclusion criteria. In both end-of-life and hastened death contexts, caregivers are motivated to ease patient suffering and may put their own needs or feelings aside to focus on that priority. Hastened death caregivers' expectation of impending death and the short duration of caregiving may result in less caregiver burden. Acceptance of the patient's condition, social support, and support from healthcare professionals all appear to improve caregiver experience. However, data on hastened death are limited. CONCLUSION: Caregivers in both groups sought closeness with the patient and reported satisfaction at having done their best to care for the patient in a critical time. Awareness of anticipated death and support from healthcare professionals appear to reduce caregiver stress. The modified stress-coping framework is an effective lens for interpreting caregivers' experiences at end of life and in the context of hastened death.


Assuntos
Cuidadores/psicologia , Família/psicologia , Assistência Terminal/psicologia , Doente Terminal/psicologia , Atitude Frente a Morte , Humanos , Pesquisa Qualitativa , Suicídio Assistido/psicologia , Assistência Terminal/métodos
17.
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
18.
Psychooncology ; 29(11): 1842-1849, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32735046

RESUMO

OBJECTIVES: The objectives of this study are to investigate how many advanced cancer patients became unconscious or non-communicative after pharmacological treatment for delirium, and to explore whether existing delirium assessment tools can successfully evaluate its severity at the end of life. METHODS: This was a secondary analysis of a registry study that examined the efficacy and safety of antipsychotics for advanced cancer patients with delirium. A total of 818 patients were recruited from 39 specialized palliative care services in Japan. The severity of delirium was measured using the Richmond Agitation-Sedation Scale-Palliative care version, the Delirium Rating Scale-Revised-98 (DRS-R-98), and the Nursing Delirium Screening Scale (Nu-DESC) on Day 3. Data from 302 patients with motor anxiety with an Agitation Distress Scale score ≥2 on Day 0 were analyzed for this study. The patients were categorized into four treatment response groups: complete response (CR: no agitation and fully communicative), partial response (PR: no/mild agitation and partially communicative), unconscious/non-communicative (UC), and no change (NC). RESULTS: On Day 3, 29 (10%; 95% confidence intervals [CI], 7-13) and 2 (1%; 95% CI, 0-2) patients became unconscious and non-communicative, respectively. Forty-four patients were categorized as CR, 97 as PR, 31 as UC, and 96 as NC. The scores of the DRS-R-98 and Nu-DESC in the UC group were rated higher than patients in the NC group were. CONCLUSIONS: A considerable number of cancer patients with delirium became unconscious or non-communicative. Existing delirium assessment tools may be inappropriate for measuring the severity of delirium in end-of-life.


Assuntos
Morte , Delírio/diagnóstico , Neoplasias/psicologia , Cuidados Paliativos/métodos , Doente Terminal/psicologia , Idoso , Antipsicóticos/uso terapêutico , Delírio/tratamento farmacológico , Delírio/enfermagem , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
19.
Psychooncology ; 29(11): 1951-1958, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32856351

RESUMO

BACKGROUND: A sense of place (SOP) is defined as the emotional bonds, values, meaning, and symbols attached to a place. AIM: To assess SOP of patients with cancer during end-of-life care at home (home-hospice service) versus at a hospital in relation to place of care, social support, and emotional distress. METHODS: Participants were 150, stage IV, cancer patients with a life expectancy of less than 6 months, as defined by oncological staff, who were not receiving any life-prolonging care. Seventy-five patients received care at home (home-hospice), and the other 75 received care at the oncology department at the hospital, by palliative unit staff. Participants completed the Brief Symptom Inventory anxiety and depression subscales, questionnaires on perceived support and both questionnaires on home SOP and hospital SOP. RESULTS: Mean scores of emotional distress were similar for patients in home-hospice and at the hospital. Home SOP among individuals receiving care at home was high, and hospital SOP was high among hospitalized individuals. The structural equation model had good fit indexes, showing that each of the SOP variables mediated the association between place of care and emotional distress. Perceived support was associated with lower distress only in the hospital setting. CONCLUSIONS: The SOP concept is relevant to understanding emotional distress in relation to place of care at end of life. Strengthening SOP in relation to place of care should be considered. As newly introduced concept regarding place of care at the EoL, SOP warrants further research.


Assuntos
Cuidados Paliativos na Terminalidade da Vida/psicologia , Angústia Psicológica , Qualidade de Vida/psicologia , Assistência Terminal/psicologia , Doente Terminal/psicologia , Adulto , Idoso , Ansiedade , Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/psicologia , Cuidados Paliativos/métodos , Apoio Social , Estresse Psicológico , Inquéritos e Questionários
20.
BMC Fam Pract ; 21(1): 136, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646380

RESUMO

BACKGROUND: As part of a broader study to improve the capacity for advance care planning (ACP) in primary healthcare settings, the research team set out to develop and validate a computerized algorithm to help primary care physicians identify individuals at risk of death, and also carried out focus groups and interviews with relevant stakeholder groups. Interviews with patients and family caregivers were carried out in parallel to algorithm development and validation to examine (1) views on early identification of individuals at risk of deteriorating health or dying; (2) views on the use of a computerized algorithm for early identification; and (3) preferences and challenges for ACP. METHODS: Fourteen participants were recruited from two Canadian provinces. Participants included individuals aged 65 and older with declining health and self-identified caregivers of individuals aged 65 and older with declining health. Semi-structured interviews were conducted via telephone. A qualitative descriptive analytic approach was employed, which focused on summarizing and describing the informational contents of the data. RESULTS: Participants supported the early identification of patients at risk of deteriorating health or dying. Early identification was viewed as conducive to planning not only for death, but for the remainder of life. Participants were also supportive of the use of a computerized algorithm to assist with early identification, although limitations were recognized. While participants felt that having family physicians assume responsibility for early identification and ACP was appropriate, questions arose around feasibility, including whether family physicians have sufficient time for ACP. Preferences related to the content of and approach to ACP discussions were highly individualized. Required supports during ACP include informational and emotional supports. CONCLUSIONS: This work supports the role of primary care providers in the early identification of individuals at risk of deteriorating health or death and the process of ACP. To improve ACP capacity in primary healthcare settings, compensation systems for primary care providers should be adjusted to ensure appropriate compensation and to accommodate longer ACP appointments. Additional resources and more established links to community organizations and services will also be required to facilitate referrals to relevant community services as part of the ACP process.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Cuidadores/psicologia , Deterioração Clínica , Diagnóstico Precoce , Médicos de Atenção Primária , Assistência Terminal , Doente Terminal , Idoso , Algoritmos , Canadá , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente , Médicos de Atenção Primária/organização & administração , Médicos de Atenção Primária/normas , Melhoria de Qualidade/organização & administração , Medição de Risco/métodos , Assistência Terminal/métodos , Assistência Terminal/psicologia , Doente Terminal/psicologia , Doente Terminal/estatística & dados numéricos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...