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1.
Clin J Oncol Nurs ; 26(5): 483-486, 2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36108216

RESUMO

The literature indicates that patients with cancer receiving palliative care experience high symptom burden resulting from disease processes and treatment side effects. However, these symptoms may not be sufficiently or consi.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Comportamento de Utilização de Ferramentas , Humanos , Oncologia , Pacientes Ambulatoriais , Cuidados Paliativos/métodos
6.
J Wound Ostomy Continence Nurs ; 49(5): 428-435, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36108226

RESUMO

PURPOSE: The purpose of this quality improvement (QI) project was to develop and implement an interactive, evidence-based pressure injury (PI) education program and evaluate the impact on frontline hospice nursing staff knowledge and practice. PARTICIPANTS AND SETTING: The QI setting was a 12-bed inpatient hospice unit in a tertiary care Veterans Affairs (VA) Medical Center in Cleveland, Ohio. Nineteen licensed and unlicensed hospice nursing staff participated in this pre-/postworkshop project. APPROACH: Chart audit determined baseline PI incidence and prevalence on the inpatient hospice unit. Interviews with key leaders informed the need to develop and implement innovative PI education opportunities. A literature review determined existing standards regarding the benefits of PI education for nursing staff but did not reveal measurable targets in hospice settings. We developed a PI education intervention based on Kolcaba's Theory of Comfort framework and a Plan-Do-Study-Act (PDSA) performance improvement model. Education was delivered in 7 workshops, lasting 2 hours each. Knowledge, practice, and comfort for inpatient hospice nursing staff were evaluated at baseline and 8 weeks following the final refresher visit. Workshop satisfaction was collected once using standard program evaluation forms after final workshop delivery. OUTCOMES: We observed a significant improvement in staff PI knowledge (P = .001) and practice (P = .001) after initial workshop attendance and repeat engagement (P = .001). There was a large magnitude of effect for overall knowledge change (d = 1.04); similarly PI care planning and practice showed a large magnitude of effect and significant improvement (P = .001, d = 2.64). Staff comfort with job duties was stable with low effect size (mean 4.52, d = 0.04), and satisfaction with the workshop education was high (100% agreement with trainer effectiveness). IMPLICATIONS FOR PRACTICE: We found that frontline hospice nursing staff knowledge and practice improved after attendance at our evidence-based PI education program. Results of this QI project have stimulated ongoing discussion on how to sustain this program in our hospice setting.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Recursos Humanos de Enfermagem , Treinamento por Simulação , Humanos , Conhecimento , Melhoria de Qualidade
8.
BMC Palliat Care ; 21(1): 148, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-35999560

RESUMO

BACKGROUND: Palliative care (PC) is an essential part of oncologic care, but its optimal role within a cancer center remains unclear. This study examines oncology healthcare providers' perspectives about the role of PC at a comprehensive cancer center (CCC). METHODS: Physicians, nurses, and other oncology healthcare providers at a CCC were surveyed for their opinions about the role of inpatient and outpatient PC, preferences for PC services, and barriers to referral. Chi-squared tests and multiple regression analyses were performed to explore associations. RESULTS: We received 137/221 completed questionnaires (61% response rate). Respondents were generally female (78%), had ≤ 10 years of service (69%), and included physicians (32%), nurses (32%), and advanced practice providers (17%). Most respondents (82%) agreed that more patients could benefit from PC. They also agreed that PC is beneficial for both outpatient and inpatient management of complex pain (96 and 88%), complex symptoms (84 and 74%), and advanced cancer patients (80 and 64%). Transition to hospice (64 vs. 42%, p = 0.007) and goals of care (62 vs. 49%, p = 0.011) provided by PC services were more valued by respondents for the inpatient than for the outpatient setting. Barriers to utilizing PC included lack of availability, unsure of when to refer, and poor communication. The majority of respondents (83%) preferred a cancer focused PC team to provide high-quality care. CONCLUSIONS: Overall, the majority of oncology health care providers believe that more patients could benefit from PC, but opinions vary regarding the roles of inpatient and outpatient PC. Barriers and areas for improvement include availability, referral process, and improved communication.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Médicos , Feminino , Humanos , Oncologia , Neoplasias/diagnóstico , Neoplasias/terapia , Cuidados Paliativos
9.
Clin J Oncol Nurs ; 26(4): 391-398, 2022 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-35939720

RESUMO

BACKGROUND: Palliative care clinicians display less burnout than oncology clinicians. Little is known about the impact of providing both oncology care and primary palliative care in the same setting. OBJECTIVES: The aim was to determine whether nurses providing primary palliative care in addition to oncology care would experience less burnout over time than nurses providing oncology care only. METHODS: The authors performed secondary analysis of the CONNECT study. Three groups of nurses were evaluated: primary palliative care, non-primary palliative care, and standard care. On study enrollment and after one year, nurses completed the Maslach Burnout Inventory. Multivariable regression analyses were performed to test differences in follow-up burnout scores between groups. FINDINGS: Overall burnout rates were low at enrollment for all groups. There were no differences in burnout scores at one year between nurses who provided palliative care and nurses in the other two groups. .


Assuntos
Esgotamento Profissional , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Enfermeiras Clínicas , Humanos , Enfermagem Oncológica , Cuidados Paliativos/métodos , Inquéritos e Questionários
11.
Int J Palliat Nurs ; 28(8): 366-375, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-36006790

RESUMO

BACKGROUND: Globally, cancer remains one of the leading causes of mortality. Palliative care is designed to meet a range of cancer patients' priority issues, including the management of pain and other cancer-associated symptoms. Routine palliative care envisages the provision of not just medical therapy, but also psychological support, social support and spiritual assistance. What constitutes the best model for palliative care remains a matter of debate. AIM: This review was undertaken with the aim to discuss different aspects of early integration of palliative care into oncological care, with a focus on patient-important outcomes. METHODS: A comprehensive search of publications was conducted with a focus on integrative palliative care for incurable cancer patients. For this purpose, the following databases and search engines were used: Scopus, PubMed, Cochrane Library, Research Gate, Google Scholar, eLIBRARY and Cyberleninka. RESULTS: A comprehensive approach with early integration of different medical services appears to be the most promising. Integrative palliative care is best provided via specialised interdisciplinary teams, given that all members maintain systemic communications and regularly exchange information. This model ensures that timely and adequate interventions are provided to address the needs of patients. CONCLUSION: Further research is needed to pinpoint the most optimal strategies to deliver palliative care and make it as tailored to the patient's demands as possible.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Cuidados Paliativos , Medidas de Resultados Relatados pelo Paciente , Humanos , Oncologia , Neoplasias/terapia , Qualidade de Vida
13.
Br J Community Nurs ; 27(8): 384-391, 2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35924904

RESUMO

This article illustrates the completion of a scoping review of the evidence relating to the role of the palliative care key worker, providing an insight into current literature. While advocated in international and national policies, the evidence underpinning this role is lacking, with only five empirical papers: two national and three international. The review identifies the need for the key worker role in palliative care; however, little consensus exists on who should adopt this role and their remits. Several implementation barriers are cited relating to communication and training. Further research on the development, implementation and consensus on the allocation of duties of the key worker role would expand the existing evidence base.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Comunicação , Humanos
14.
J Pain Symptom Manage ; 64(4): 319-329, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35835429

RESUMO

BACKGROUND: Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary palliative care among people living with serious illness and their families and the readiness of primary healthcare providers to deliver primary palliative care in Nigeria. METHODS: Qualitative descriptive interview study with 48 participants: people living with serious illness (n=21) and their family caregivers (n=15), healthcare providers (n=12). Data were analysed using thematic analysis. RESULTS: Three major themes were identified. 1.) Engaging patients and families. 2.) Managing patients and families' expectations and preferences. 3.) Addressing staffing-related issues. Patients and families have existing trust and bonds from using primary healthcare but lack individual agency necessary for person-centered care decisions. They expect an easily accessible service, opportunities for social interaction and adequate communication. Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. CONCLUSIONS: Our findings have identified specific approaches to implement the WHO policy on integrated primary palliative care. Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers' roles to ensure staff work within their competencies and training.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Cuidadores , Humanos , Nigéria , Pesquisa Qualitativa
15.
J Pain Symptom Manage ; 64(4): e217-e226, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35850443

RESUMO

Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Analgésicos Opioides , Humanos , Cuidados Paliativos
16.
BMJ Open ; 12(7): e065236, 2022 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-35879001

RESUMO

INTRODUCTION: Despite the known benefit to patients and families, discussions about goals, values and preferences for medical care in advancing serious illness often do not occur. Many system and clinician factors, such as patient and clinician reticence and shortage of specialty palliative care teams, contribute to this lack of communication. To address this gap, we designed an intervention to promote goals-of-care conversations and palliative care referrals in the hospital setting by using trained palliative care educators and video decision aids. This paper presents the rationale, design and methods for a trial aimed at addressing barriers to goals-of-care conversations for hospitalised adults aged 65 and older and those with Alzheimer's disease and related Dementias, regardless of age. METHODS AND ANALYSIS: The Video Image about Decisions to Improve Ethical Outcomes with Palliative Care Educators is a pragmatic stepped wedge, cluster randomised controlled trial, which aims to improve and extend goals-of-care conversations in the hospital setting with palliative care educators trained in serious illness communication and video decision aids. The primary outcome is the proportion of patients with goals-of-care documentation in the electronic health record. We estimate that over 9000 patients will be included. ETHICS AND DISSEMINATION: The Institutional Review Board (IRB) at Boston Medical Center will serve as the single IRB of record for all regulatory and ethical aspects of this trial. BMC Protocol Number: H-41482. Findings will be presented at national meetings and in publications. This trial is registered at ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT04857060; ClinicalTrials.gov.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Adulto , Comunicação , Hospitalização , Hospitais , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
J Crit Care ; 71: 154115, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35907272

RESUMO

PURPOSE: Death is common in intensive care units, and integrating palliative care enhances outcomes. Most research has been conducted in high-income countries. The aim is to understand what is known about the type and topics of research on the provision of palliative care within intensive care units in low- and middle-income countries MATERIALS AND METHODS: Scoping review with nine databases systematically searched for literature published in English on palliative care in intensive care units in low- and middle- income settings (01/01/1990 to 31/05/2021). Two reviewers independently checked search results and extracted textual data, which were analyzed and represented as themes. RESULTS: Thirty papers reported 19 empirical studies, two clinical case reports and six discussion papers. Papers originated from Asia and Africa, primarily using observational designs and qualitative approaches, with no trials or other robust evaluative or comparative studies. No studies directly sought data from patients or families. Five areas of research focus were identified: withholding and withdrawing treatment; professional knowledge and skills; patient and family views; culture and context; and costs of care. CONCLUSIONS: Palliative care in intensive care units in low-and middle-income countries is understudied. Research focused on the specific needs of intensive care in low- and middle-income countries is required to ensure optimal patient outcomes.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Países em Desenvolvimento , Humanos , Unidades de Terapia Intensiva , Cuidados Paliativos
19.
Eur J Cancer Care (Engl) ; 31(5): e13642, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35822246

RESUMO

INTRODUCTION: In palliative care, the prevention and relief of fatigue are regarded as crucial goals in patients with cancer. METHODS: A systematic review was carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Searches were conducted in Medline (through PubMed), Web of Science, Open Gray, Scielo, Cochrane, CINAHL and EMBASE. All instruments found in each study were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: A total of 5598 articles were identified in the different databases. In total, 57 studies describing 19 instruments were included in this study. The main properties evaluated were internal consistency, cross-cultural validity, hypotheses testing and responsiveness. All studies were evaluated with the Strobe scale with a score greater than 6 points. CONCLUSIONS: According to the quality methodological results, Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Questionnaire, European Organisation for Research and Treatment of Cancer Quality of Life 15-item Questionnaire for Palliative Care and Palliative Care Quality of Life Instrument are the recommended instruments used for assessing cancer-related fatigue in palliative care. PROPESRO registration number: CRD42020206783.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Fadiga/etiologia , Fadiga/terapia , Humanos , Neoplasias/complicações , Neoplasias/terapia , Cuidados Paliativos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Inquéritos e Questionários
20.
Ann Palliat Med ; 11(8): 2646-2657, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35815448

RESUMO

BACKGROUND: Early specialty palliative care (PC) integration improves oncologic outcomes. We aimed to examine longitudinal relationships between specialty PC and palliative radiotherapy (RT), temporal distribution of symptoms, and predictors of earlier specialty PC. METHODS: We retrospectively reviewed 135 patients with metastatic cancer who received palliative RT at our institution (7/2017-2/2018) and who had died by final study follow-up (6/2021). Descriptive statistics summarized frequencies of clinical visits and symptoms over relative survival time (quartiles 1-3: first 75% of life remaining from metastatic diagnosis to death versus quartile 4: last 25% of life remaining from metastatic diagnosis to death). Logistic regression analyses revealed predictors of receiving earlier (quartiles 1-3) versus later (quartile 4) specialty PC. RESULTS: There were 16.3%, 10.4%, 26.7%, and 46.7% of palliative RT consultations, compared to 4.7%, 7.6%, 14.0%, and 73.7% of specialty PC visits, that occurred in quartiles 1, 2, 3, and 4, respectively. On multivariable analysis, pain significantly predicted for receiving earlier specialty PC [odds ratios (OR) =15.34; 95% confidence interval (CI): 2.16-324.23; P=0.020], while patients with ≥2 prior chemotherapy regimens were less likely to have received earlier specialty PC (OR =0.16; 95% CI: 0.04-0.58; P=0.009). The most common reasons for first specialty PC visit were addressing pain (61.0%) and goals of care (19.5%). Overall, 73.3% (99/135) of patients were referred to hospice and 9.6% (13/135) received either palliative RT, chemotherapy, or surgery within 30 days of death. CONCLUSIONS: Nearly 47% of palliative RT visits compared with 74% of specialty PC visits occurred in the last quarter of life from metastatic diagnosis to death. Multidisciplinary efforts are needed to manage longitudinal symptoms and offer goal-concordant care.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias , Morte , Humanos , Neoplasias/radioterapia , Dor , Cuidados Paliativos , Estudos Retrospectivos
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