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1.
Rev. enferm. UERJ ; 29: e51932, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224598

RESUMO

Objetivo: analisar a produção do conhecimento sobre a experiência da família acerca dos cuidados paliativos da criança com câncer hospitalizada na unidade de terapia intensiva e discutir o papel da enfermagem no atendimento à família da criança com câncer frente aos cuidados paliativos. Método: revisão integrativa realizada na PUBMED, LILACS, SCOPUS, SCIELO e CINAHL entre janeiro e março de 2020. Resultados: a amostra foi composta por 13 artigos, originando duas categorias: O impacto do cuidado paliativo da criança com câncer na dinâmica familiar e o cuidado multiprofissional, em especial dos enfermeiros, à família da criança com câncer. Conclusão: os estudos revelaram o panorama nacional e internacional dos cuidados paliativos à criança com câncer e a desestruturação da dinâmica familiar nos aspectos físicos, sociais, psicológicos, e financeiros, caracterizando o período como estressante e doloroso. Os enfermeiros estabelecem condutas terapêuticas objetivando promover qualidade de vida para crianças em cuidados paliativos e seus familiares.


Objective: to examine production of knowledge on families' experience of palliative care for children with cancer hospitalized in an intensive care center and discuss the role of nursing in assisting the family of the child in palliative cancer care. Method: this integrative review was conducted on PubMed, LILACS, Scopus, SciELO and CINAHL between January and March 2020. Results: from the sample of 13 articles, two categories originated: The impact of palliative cancer care for children on family dynamics and multiprofessional care, especially by nurses, for the family of the child with cancer. Conclusion: the studies revealed the national and international panorama of palliative care for children with cancer and the breakdown of physical, social, psychological, and financial family dynamics, characterizing the period as stressful and painful. Nurses establish therapeutic approaches aimed at promoting quality of life for children in palliative care and their families.


Objetivo: analizar la producción de conocimiento sobre la experiencia familiar en los cuidados paliativos de niños con cáncer, hospitalizados en la unidad de cuidados intensivos, y discutir el papel de la enfermería en la asistencia a la familia del niño con cáncer frente a los cuidados paliativos. Método: Revisión integradora realizada en PUBMED, LILACS, SCOPUS, SCIELO y CINAHL entre enero y marzo de 2020. Resultados: La muestra estuvo conformada por 13 artículos, originando dos categorías: El impacto de los cuidados paliativos para niños con cáncer en la dinámica familiar y los cuidados multiprofesionales, especialmente de las enfermeras, a la familia del niño con cáncer. Conclusión: Los estudios revelaron el panorama nacional e internacional de los cuidados paliativos para niños con cáncer y la ruptura de la dinámica familiar en aspectos físicos, sociales, psicológicos y económicos, caracterizándolo como un período estresante y doloroso. Las enfermeras establecen enfoques terapéuticos dirigidos a promover la calidad de vida de los niños en cuidados paliativos y sus familias.


Assuntos
Humanos , Masculino , Feminino , Criança , Cuidados Paliativos , Família/psicologia , Criança Hospitalizada , Conhecimentos, Atitudes e Prática em Saúde , Unidades de Terapia Intensiva , Neoplasias/terapia , Papel do Profissional de Enfermagem , Neoplasias/enfermagem , Relações Enfermeiro-Paciente
2.
Rev. enferm. UERJ ; 29: e52717, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224536

RESUMO

Objetivo: compreender a construção dos significados da morte pelos profissionais de saúde frente ao cuidado à pessoa com câncer. Método: estudo qualitativo realizado em ambiente online, com a participação de 34 profissionais de saúde. Foram realizadas entrevistas semiestruturadas, interpretadas segundo análise temática. Resultados: duas categorias analíticas emergiram dos dados, indicando que os significados atribuídos à morte pelos participantes foram: como um processo inerente ao ciclo da vida humana, passagem para a outra vida, e fim do sofrimento tanto do paciente quanto dos profissionais de saúde. As dificuldades que apontaram em lidar com a morte se referem à falta de suporte psicológico, escassez de conhecimento sobre morte, cuidados paliativos e comunicação de más notícias. Conclusão: os profissionais construíram diferentes significados à morte de seus pacientes, tais como um processo natural da vida, vontade de um ser superior, passagem para uma nova existência e término do sofrimento dessas pessoas.


Objective: to understand the construction of meanings of death by healthcare professionals caring for people with cancer. Method: this qualitative study was carried out in an online environment through semi-structured interviews of 34 health professionals, which were interpreted using thematic analysis. Results: two analytical categories emerged from the data, indicating that the meanings attributed to death by the participants were: a process inherent in the human life cycle, a transition to the next life, and an end to the suffering of both patient and health professionals. The difficulties they pointed to in dealing with death related to lack of psychological support, lack of knowledge about death, palliative care, and communicating bad news. Conclusion: the professionals constructed different meanings to their patients' deaths: a natural process of life, the will of a higher being, a transition to a new existence, and an end to these people's suffering.


Objetivo: comprender la construcción de los significados de la muerte desde el punto de vista de los profesionales de la salud ante el cuidado a la persona con cáncer. Metodología: estudio cualitativo realizado en un entorno online, con la participación de 34 profesionales de la salud. Se realizaron entrevistas semiestructuradas, interpretadas según análisis temático. Resultados: de los datos surgieron dos categorías analíticas que indicaron que los significados atribuidos a la muerte por los participantes fueron: como u proceso inherente al ciclo de vida humano, transición a otra vida y fin al sufrimiento tanto del paciente como de los profesionales de la salud. Las dificultades que señalaron para afrontar la muerte se refieren a la falta de apoyo psicológico, escasez de conocimiento sobre la muerte, cuidados paliativos y comunicación de malas noticias. Conclusión: los profesionales han construido diferentes significados para la muerte de sus pacientes: un proceso natural de la vida, la voluntad de un ser superior, un paso a una nueva existencia y el fin del sufrimiento de estas personas.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Prática Profissional , Atitude Frente a Morte , Pessoal de Saúde , Morte , Oncologistas , Neoplasias , Cuidados Paliativos , Pessoal de Saúde/psicologia , Pesquisa Qualitativa , Oncologistas/psicologia , Hospitais , Neoplasias/psicologia
3.
Rev. colomb. anestesiol ; 49(4): e303, Oct.-Dec. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1341242

RESUMO

Abstract Life support withdrawal can be a challenging decision, but it should be considered as an option when death is inevitable or recovery to an acceptable quality of life is not possible. The process is beset by obstacles that must be overcome to finally offer patients comfort and a peaceful death. In this article, we offer a series of tools that seek to solve the challenges of palliative extubation, as well as a protocol that could facilitate the decision to withdraw life support, making palliative extubation an alternative to consider instead of artificially prolonging life at the expense of unacceptable human and economic costs.


Resumen La interrupción de la asistencia vital puede ser una decisión complicada, aun cuando se debe considerar como una opción cuando la muerte es inevitable o la recuperación a una calidad de vida aceptable no es posible. A lo largo del proceso se encuentran obstáculos que se deben sortear para finalmente ofrecer a los pacientes una muerte tranquila y confortable. En este artículo ofrecemos una serie de herramientas que buscan solucionar los desafíos de la extubación paliativa y presentamos una guía de extubación que podría facilitar la decisión de retiro del soporte vital, haciendo de la extubación paliativa una alternativa por considerar en lugar de prolongar la vida de manera artificial a expensas de un costo humano y económico inaceptable.


Assuntos
Humanos , Cuidados Paliativos , Direito a Morrer , Extubação , Cuidados para Prolongar a Vida , Qualidade de Vida , Cuidados Críticos , Protocolos/prevenção & controle
4.
Rev. SPAGESP ; 22(2): 5-18, jul.-dez. 2021. ilus, tab
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1340809

RESUMO

RESUMO A sociedade contemporânea caracteriza-se por um processo de envelhecimento permeado por estereótipos relacionados à proximidade da morte, negada pela sociedade ocidental. Para descortinar essa temática, objetivou-se identificar os significados que idosos em cuidados paliativos atribuem à morte e à vida. Realizou-se dois grupos focais com 18 idosos em cuidados paliativos, compreendidos por análise textual no software IRaMuTeQ. Os resultados organizaram-se em quatro classes: "Significações sobre a morte" retrata sua aceitação, "As relações entre vida e morte na velhice" apresenta a ambivalência dessa díade, "Significações sobre a vida na velhice" avalia essa fase da vida, "Atividades diárias e ressignificação da vida" aborda seus novos papeis. Conclui-se que a rede de apoio e a espiritualidade influenciam a significação da morte pelo idoso.


Contemporary society is characterized by an aging process permeated by stereotypes related to the proximity of death, denied by Western society. To unveil this theme, the objective was to identify the meanings that elderly in palliative care attribute to death and life. Two focus groups were held with 18 elderly in palliative care, understood by textual analysis in the IRaMuTeQ software. The results were organized into four classes: "Meanings about death" portrays their acceptance, "The relationships between life and death in old age" presents the ambivalence of this dyad, "Meanings about life in old age" assesses this phase of life, "Daily activities and life resignification" addresses their new roles. It is concluded that the support network and spirituality influence the meaning of death by the elderly.


RESUMEN La sociedad contemporánea es demarcada por proceso de envejecimiento impregnado de estereotipos respecto a la proximidad con la muerte. En este entorno, el objetivo de este estudio fue identificar los significados que las personas mayores, en cuidados paliativos, atribuyen a la muerte y la vida. Así, se realizaron dos grupos focales con 18 personas mayores en cuidados paliativos para la recogida de datos, y luego sometida a análisis textual en el software IRaMuTeQ. Los resultados se organizaron en cuatro clases: "Significados sobre la muerte" retrata su aceptación, "Las relaciones entre la vida y la muerte en la vejez" presenta la ambivalencia de esta díada, "Significados sobre la vida en la vejez" evalúa esta fase de la vida, "Actividades diarias y la resignificación de la vida "aborda sus nuevos roles. Se concluye que la red de apoyo y la espiritualidad influyen en el significado de la muerte de los ancianos.


Assuntos
Humanos , Idoso , Cuidados Paliativos , Religião , Envelhecimento , Atitude Frente a Morte , Espiritualidade
5.
Rev Infirm ; 70(275): 35-36, 2021 Nov.
Artigo em Francês | MEDLINE | ID: mdl-34752359

RESUMO

The return back home of certain patients treated for cancer in the palliative phase requires efficient coordination of caregivers in order to guarantee the well-being of patients and the quality and safety of the care provided. Two hospital coordination nurses have developed a quality approach that aims to reinforce the security of technical care at home in a perfect coordination of all the city-hospital contributors.


Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Hospitais , Humanos , Oncologia , Neoplasias/terapia , Cuidados Paliativos
6.
BMC Palliat Care ; 20(1): 175, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34758792

RESUMO

BACKGROUND: Specialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs' service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates. METHODS: We performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant. RESULTS: In total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23-1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs' years of existence, staffing, their level of education, participation in other departments' team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals. CONCLUSION: In the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases.


Assuntos
Cuidados Paliativos , Qualidade de Vida , Estudos Transversais , Hospitais , Humanos , Países Baixos , Encaminhamento e Consulta
7.
Health Aff (Millwood) ; 40(11): 1811-1812, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34724424
8.
BMC Palliat Care ; 20(1): 180, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802436

RESUMO

BACKGROUND: Acute care and palliative care (PC) are described as different incompatible organisational care cultures. Few studies have observed the actual meeting between these two cultures. In this paper we report part of ethnographic results from an intervention study where a palliative care consultation team (PCCT) used an integrative bedside education approach, trying to embed PC principles and interventions into daily practice in acute wards. PURPOSE: To study the meeting and interaction of two different care cultures, palliative care and curative acute wards, when a PCCT introduces consulting services to acute wards regarding end-of-life palliative care, focusing on the differences between the cultures. METHODS: An ethnographic study design was used, including observations, interviews and diary entries. A PCCT visited acute care wards during 1 year. The analysis was inspired by Spradleys ethnography. RESULTS: Three themes were found: 1) Anticipations meets reality; 2) Valuation of time and prioritising; and 3) The content and creation of palliative care. CONCLUSION: There are many differences in values, and the way PC are provided in the acute care wards compared to what a PCCT expects. The didactic challenges are many and the PC require effort.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Antropologia Cultural , Humanos , Cuidados Paliativos , Encaminhamento e Consulta
9.
BMC Palliat Care ; 20(1): 179, 2021 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-34802450

RESUMO

BACKGROUND: Efforts inequities in access to palliative and end-of-life care require comprehensive understanding about the extent of and reasons for inequities. Most research on this topic examines differences in receipt of care. There is a need, particularly in the UK, for theoretically driven research that considers both receipt of care and the wider factors influencing the relationship between socioeconomic position and access to palliative and end-of-life care. METHODS: This is a mixed studies narrative synthesis on socioeconomic position and access to palliative and end-of-life care in the UK. Study searches were conducted in databases AMED, Medline, Embase, CINAHL, SocIndex, and Academic Literature Search, as well as grey literature sources, in July 2020. The candidacy model of access, which describes access as a seven-stage negotiation between patients and providers, guided study searches and provided a theoretical lens through which data were synthesised. RESULTS: Searches retrieved 5303 studies (after de-duplication), 29 of which were included. The synthesis generated four overarching themes, within which concepts of candidacy were evident: identifying needs; taking action; local conditions; and receiving care. CONCLUSION: There is not a consistent or clear narrative regarding the relationship between socioeconomic position and receipt of palliative and end-of-life care in the UK. Attempts to address any inequities in access will require knowledge and action across many different areas. Key evidence gaps in the UK literature concern the relationship between socioeconomic position, organisational context, and assessing need for care.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Assistência Terminal , Humanos , Cuidados Paliativos , Fatores Socioeconômicos , Reino Unido
10.
Am J Hosp Palliat Care ; 38(12): 1541-1543, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34806434

RESUMO

Caring for the Family Caregiver is published by Oxford University Press and introduces the novel framework of the Family Caregiver Communication Typology. The volume offers a close analysis of caregiver health literacy and patient outcomes and invites readers to consider the family system as the driver in shaping how family caregivers deal with chronic illness demands. The expertise of all authors (three health communication scholars and one nurse who is a health literacy expert) in the analysis illuminates the delicate balance between caregivers' ability to understand and communicate in the context of social determinants of health. The book shares the interwoven challenges of palliative care, family caregiving, and health literacy. Caring for the Family Caregiver establishes the urgent call to address family caregiver information and communication needs and leaves the reader empowered to make changes in their own clinical practice communication and/or develop family caregiving research that addresses cultural and social factors.


Assuntos
Cuidadores , Letramento em Saúde , Livros , Comunicação , Humanos , Cuidados Paliativos , Universidades
11.
BMC Palliat Care ; 20(1): 178, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794399

RESUMO

BACKGROUND: The availability of palliative care facilities for children vary considerably among the European member states. In Romania, a country where health expenditure is among the lowest in Europe, palliative care has been mainly provided by charitable organizations. Despite the high number of children needing palliative care, there is scant literature and research available on paediatric palliative care in Romania. The study explores the viewpoints of various paediatric oncology providers with regard to paediatric palliative care provision in Romania. METHODS: Four mixed focus groups were conducted at four university-affiliated paediatric oncology centres located in three distinct Romanian regions (Bucuresti-llfov, Nord-Est and Nord-Vest). The focus groups were analyzed using thematic coding. RESULTS: For many healthcare professionals, emotional burden inherent to the profession; unhealthy work-life balance and understaffing were among the biggest barriers to the successful integration of pediatric palliative care. The lack of staff was attributed to a shortage of financial resources, and to the persisting cultural stigma surrounding palliative care and oncology. Also political turmoil was identified as an important obstacle to palliative care implementation. CONCLUSION: Significant barriers persist limiting the broader implementation of pediatric palliative care in Romania. In order to render palliative care in pediatric oncology more sustainable, more attention should be paid to the mental health care of healthcare professionals working in this field, to the development of mobile palliative care services and to the emigration of skilled medical staff.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Criança , Grupos Focais , Humanos , Pesquisa Qualitativa , Romênia
12.
Washington, D.C.; OPS; 2021-11-01. (OPS/NMH/MH/21-0033).
em Espanhol | PAHO-IRIS | ID: phr-55093

RESUMO

El Fondo Estratégico para Suministros de Salud Pública de la Organización Panamericana de la Salud (Fondo Estratégico) ayuda a asegurar la disponibilidad de los medicamentos esenciales para las enfermedades no transmisibles, incluidos los medicamentos para cuidados paliativos, a un precio competitivo para todos los países. El Fondo Estratégico es un mecanismo integrado de adquisiciones mancomunado, y los productos adquiridos cumplen las normas internacionales de seguridad, eficacia y calidad. En este folleto se presenta información sobre los medicamentos y formulaciones disponibles para las enfermedades no transmisibles mediante el Fondo Estratégico, agrupados por categorías: enfermedades cardiovasculares, diabetes, cáncer, enfermedades respiratorias crónicas y cuidados paliativos. Incluye ejemplos de los descuentos logrados por el Fondo Estratégico para los medicamentos esenciales, con el objetivo de procurar precios competitivos para América Latina y el Caribe.


Assuntos
Doenças não Transmissíveis , Cuidados Paliativos , Diabetes Mellitus , Doenças Cardiovasculares , Neoplasias , Doenças Respiratórias , Medicina , Medicamentos Essenciais , Acesso a Medicamentos Essenciais e Tecnologias em Saúde
13.
Washington, D.C.; PAHO; 2021-11-01. (PAHO/NMH/MH/21-0033).
em Inglês | PAHO-IRIS | ID: phr-55092

RESUMO

The Pan American Health Organization’s Revolving Fund for Strategic Public Health Supplies (Strategic Fund) helps ensure the availability of essential medicines for noncommunicable diseases, including palliative care medicines, at a competitive price for all countries. The Strategic Fund is an integrated pooled procurement mechanism, and the products purchased through the Strategic Fund meet international standards in safety, efficacy, and quality. This brochure presents information on the medications and their formulations available through the Strategic Fund for noncommunicable diseases, summarized by category: cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, and palliative care. The brochure includes examples of price reductions achieved by the Strategic Fund for key essential medicines, ensuring competitive prices for these for Latin America and the Caribbean.


Assuntos
Doenças não Transmissíveis , Medicina , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Cuidados Paliativos , Doenças Cardiovasculares , Diabetes Mellitus , Neoplasias , Doenças Respiratórias , Medicamentos Essenciais
14.
Med Lav ; 112(5): 387-400, 2021 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-34726666

RESUMO

BACKGROUND: In the healthcare landscape, various protective factors are identified, such as meaning in life (MiL), namely what gives sense to life events. However, little is known about this construct in the healthcare population. OBJECTIVES: To describe MiL among healthcare professionals employed in palliative care and neuro-rehabilitation medicine, unveiling possible differences related to medical specialty and socio-demographic characteristics. METHODS: In this cross-sectional and multicentre study, palliative care and neuro-rehabilitation professionals were recruited. MiL was evaluated with the Schedule for Meaning in Life Evaluation (SMiLE), which provides a list of meaningful areas, as well as related overall indexes of satisfaction (IoS), weighting (IoW), weighted satisfaction (IoWS). Descriptive statistics, t-test, chi-square, linear and binary logistic regressions were performed. RESULTS: Overall, 297healthcare professionals (palliative care=89, neuro-rehabilitation medicine=208, 47% of participants ≤ 40 years old) completed the evaluation. The sample was intra- and inter-groups heterogeneous, in particular concerning age and professional role. Conversely, no significant group differences emerged in MiL indexes comparisons, nor in the number of MiL listed areas. As for MiL areas, the category "family" increased the IoWS index, while terms related to "finances" contributed to decrease it. Comparing specialties, palliative care professionals were more likely to report areas like "partnership", "social commitment", and "satisfaction". Nurses (n=116), nurse aides (n=47), and therapists (n=67) were more likely to mention health-related terms (e.g. health, physical wellbeing) than physicians and psychologists (n=65). CONCLUSION: This study highlighted MiL areas among professionals employed in palliative care and neurorehabilitation specialties, providing informative suggestions for tailored health prevention programs which should pay particular attention to social and family relationships, socio-economic status, and health.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Adulto , Estudos Transversais , Atenção à Saúde , Humanos , Satisfação Pessoal
15.
Rev Med Suisse ; 17(757): 1890-1893, 2021 Nov 03.
Artigo em Francês | MEDLINE | ID: mdl-34738764

RESUMO

The increasing life expectancy, the earlier detection of terminal illnesses and the increasing complexity of care pathways led us to propose an innovative response within the Neuchâtel Hospital Network (RHNe), in the form of a mixed intra-hospital mobile team (GSPmob), composed of doctors and nurses from geriatrics and palliative care. Through geriatric and palliative assessment, we are able to highlight the patient's different medical problems. Our team, after two years of existence, has met our patients' needs as well as the hospital teams' needs. And yet we encountered certain challenges. Our current objective is to describe our experience by presenting our results and difficulties.


Assuntos
Geriatria , Cuidados Paliativos , Idoso , Hospitais , Humanos , Expectativa de Vida , Equipe de Assistência ao Paciente
16.
Artigo em Inglês | MEDLINE | ID: mdl-34769879

RESUMO

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.


Assuntos
Planos de Pagamento por Serviço Prestado , Custos de Cuidados de Saúde , Humanos , Estilo de Vida , Cuidados Paliativos , Pesquisa
17.
Lancet Oncol ; 22(11): e517-e529, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34735820

RESUMO

National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.


Assuntos
Planejamento em Saúde/legislação & jurisprudência , Neoplasias/prevenção & controle , Detecção Precoce de Câncer , Monitoramento Epidemiológico , Implementação de Plano de Saúde/legislação & jurisprudência , Humanos , Região do Mediterrâneo/epidemiologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Cuidados Paliativos
18.
BMC Palliat Care ; 20(1): 176, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34763677

RESUMO

BACKGROUND: Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. METHODS: The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. RESULTS: After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients' needs and possibilities for ensuring optimal quality of life, the family included. CONCLUSIONS: Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings - including implementation, patient and family outcomes, and experiences of patient, family and personnel.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Pessoal de Saúde , Humanos , Projetos Piloto , Qualidade de Vida
19.
Artigo em Inglês | MEDLINE | ID: mdl-34769747

RESUMO

(1) Background: Nurses can find people with advanced diseases or in their last days of life during their professional careers and in many different care settings. For this reason, they need to have at least a basic level of palliative care education since they are the professional cohort treating these patients in a very close way. This research aims to determine the level of knowledge in palliative care of Spanish nurses and establish any possible difference based on their experience and training in palliative care. (2) Methods: A cross-sectional design using survey methods (distributed an online questionnaire) aimed at Spanish registered nurses. A validated questionnaire (PCQN-SV) was used to determine the level of knowledge in palliative care; information on some variables to characterize the population was also collected (experience and education in palliative care, years of professional experience, academic level, and others). Uni and bivariate descriptive analyses were performed. A binary logistic regression model was also developed to identify those variables that influenced obtaining results higher than the population's average. (3) Results: Spanish nurses have a medium-low level of knowledge in palliative care, higher in those who have previous experience or education in this area. Statistically significant differences were also found according to the area in which their caring activity was developed. (4) Conclusions: It is necessary to implement strategies for the basic training of nursing professionals in palliative care to offer quality care to people in advanced stages of illnesses or at the end of their lives.


Assuntos
Enfermeiras e Enfermeiros , Cuidados Paliativos , Competência Clínica , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Inquéritos e Questionários
20.
J Orthop Sci ; 26(6): 1107-1112, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34755637

RESUMO

BACKGROUND: The complication rate for palliative surgery in spinal metastasis is relatively high, and major complications can impair the patient's activities of daily living. However, surgical indications are determined based primarily on the prognosis of the cancer, with the risk of complications not truly considered. We aimed to identify the risk predictors for perioperative complications in palliative surgery for spinal metastasis. METHODS: A multicentered, retrospective review of 195 consecutive patients with spinal metastasis who underwent palliative surgeries with posterior procedures from 2001 to 2016 was performed. We evaluated the type and incidence of perioperative complications within 14 days after surgery. Patients were categorized into either the complication group (C) or no-complication group (NC). Univariate and multivariate analyses were used to identify potential predictors for perioperative complications. RESULTS: Thirty patients (15%) experienced one or more complications within 14 days of surgery. The most frequent complications were surgical site infection (4%) and motor weakness (3%). A history of diabetes mellitus (C; 37%, NC; 9%: p < 0.01) and surgical time over 300 min (C; 27%, NC; 12%: p < 0.05) were significantly associated with complications according to univariate analysis. Increased blood loss and non-ambulatory status were determined to be potential risk factors. Of these factors, multivariate logistic regression revealed that a history of diabetes mellitus (OR: 6.6, p < 0.001) and blood loss over 1 L (OR: 2.7, p < 0.05) were the independent risk factors for perioperative complications. There was no difference in glycated hemoglobin A1c between the diabetes patients with and without perioperative complications. CONCLUSIONS: Diabetes mellitus should be used for the risk stratification of surgical candidates regardless of the treatment status, and strict prevention of bleeding is needed in palliative surgeries with posterior procedures to mitigate the risk of perioperative complications.


Assuntos
Fusão Vertebral , Neoplasias da Coluna Vertebral , Atividades Cotidianas , Humanos , Cuidados Paliativos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Coluna Vertebral/cirurgia
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