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1.
BMJ Open ; 9(12): e033905, 2019 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-31874895

RESUMO

OBJECTIVES: To explore current practice in relation to palliative and end of life care in prisons, and to make recommendations for its future provision. DESIGN: A rapid literature review of studies using qualitative, quantitative and mixed-methods, with a narrative synthesis of results. DATA SOURCES: Six databases searched between January 2014 to December 2018: ASSIA, CINAHL, Embase, MEDLINE, National Criminal Justice Reference Service Abstracts and Scopus. ELIGIBILITY CRITERIA: Primary research articles reporting qualitative or quantitative findings about palliative and end of life care in prisons, published in peer-reviewed, English language journals between January 2014 to December 2018. PARTICIPANTS: Prisoners, prisoners' families, prison healthcare staff and other prison staff. DATA EXTRACTION/SYNTHESIS: Data extracted included: citation, design, aim, setting, sample/population, methods and key findings. Data were analysed thematically then subject to a narrative synthesis in order to answer the research questions. QUALITY APPRAISAL: Two researchers independently appraised articles using the Qualsyst tool, by Kmet et al (2004). Aggregate summary quality scores are included with findings. Articles were not excluded based on quality appraisal. RESULTS: 23 articles were included (16 qualitative, 6 quantitative, 1 mixed methods). Top three findings (by prevalence) were: fostering relationships with people both inside and outside of prison is important to prisoners with palliative and end of life care needs, inmate hospice volunteers are able to build and maintain close relationships with the prisoners they care for and the conflicting priorities of care and custody can have a negative impact on the delivery of palliative and end of life care in prisons. CONCLUSIONS: The key findings are: relationships are important to prisoners at the end of life, inmate hospice volunteers can build close bonds with the prisoners in their care and the prison environment and regime conflicts with best practices in palliative and end of life care. Directions for future research are also identified. PROSPERO REGISTRATION NUMBER: PROSPERO ID: CRD42019118737. Registered January 2019.


Assuntos
Cuidados Paliativos na Terminalidade da Vida/métodos , Cuidados Paliativos/métodos , Prisões/organização & administração , Atitude do Pessoal de Saúde , Acessibilidade aos Serviços de Saúde/normas , Humanos , Prisioneiros , Pesquisa Qualitativa
2.
BMC Palliat Care ; 18(1): 116, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864331

RESUMO

BACKGROUND: Despite evidence that referral to pediatric palliative care reduces suffering and improves quality of life for patients and families, many clinicians delay referral until the end of life. The purpose of this article is to provide a conceptual model for why clinical teams delay discussing palliative care with parents. DISCUSSION: Building on a prior model of parent regoaling and relevant research literature, we argue for a conceptual model of the challenges and facilitators a clinical team might face in shifting from a restorative-focused treatment plan to a plan that includes palliative aspects, resulting in a subspecialty palliative care referral. Like patients and families, clinicians and clinical teams may recognize that a seriously ill patient would benefit from palliative care and shift from a restorative mindset to a palliative approach. We call this transition "clinician regoaling". Clinicians may experience inhibitors and facilitators to this transition at both the individual and team level which influence the clinicians' willingness to consult subspecialty palliative care. The 8 inhibitors to team level regoaling include: 1) team challenges due to hierarchy, 2) avoidance of criticizing colleagues, 3) structural communication challenges, 4) group norms in favor of restorative goals, 5) diffusion of responsibility, 6) inhibited expression of sorrow, 7) lack of social support, 8) reinforcement of labeling and conflict. The 6 facilitators of team regoaling include: 1) processes to build a shared mental model, 2) mutual trust to encourage dissent, 3) anticipating conflict and team problem solving, 4) processes for reevaluation of goals, 5) sharing serious news as a team, 6) team flexibility. CONCLUSIONS: Recognizing potential team level inhibitors to transitioning to palliative care can help clinicians develop strategies for making the transition more effectively when appropriate.


Assuntos
Cuidados Paliativos/métodos , Atenção Primária à Saúde/métodos , Encaminhamento e Consulta/normas , Objetivos , Humanos , Pediatria/métodos , Pediatria/normas , Atenção Primária à Saúde/normas , Qualidade de Vida/psicologia , Apoio Social
3.
Chin Clin Oncol ; 8(6): 66, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31865715

RESUMO

Patients with incurable cancer face lots of problems before they expire. Complications resulting from cancer or its treatment are a significant determinant of the quality of life of cancer patients. It is of outmost importance to make use of all treatment options in order to improve their survival and quality of life. Nowadays, available are a number of Interventional Radiology procedures that are minimally invasive, can be performed under local anesthesia or conscious sedation and are indispensable in helping patient through the cancer disease process. These techniques can be broadly classified into drainage of fluid collections, decompression and relief of obstruction, pain and tumor burden reduction, vascular and gastrointestinal tract access as well as hemostasis. The purpose of this article is to describe the basic concepts of minimally invasive techniques applied as palliative care therapies in the cancer patients. Controversies concerning techniques and products and the need for patient-centered tailored approaches will be discussed.


Assuntos
Neoplasias/terapia , Cuidados Paliativos/métodos , Humanos
4.
Ann Palliat Med ; 8(5): 769-774, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31865737

RESUMO

Although palliative care (PC) has become increasingly familiar, considerable gaps persist in access to and use of services. Community-based programs remain rare, and low-income, minority communities significantly under-utilize hospice and palliative services. We used community-based participatory research (CBPR) methods to conduct a mixed-methods community needs assessment of seriously-ill older adults (n=100) and providers from community-based programs and churches (n=41) in an urban medically-underserved community in the U.S. to explore: (I) the prevalence and severity of illness-related symptoms and psychosocial-spiritual concerns; (II) the scope and quality of community supports helping older adults manage their symptoms; and (III) the perceptions and utilization of palliative and supportive care services among older adults and community-based service providers. Participants reported high rates of chronic illness-related symptoms (i.e., pain, fatigue, sleeping difficulties, depression, and anxiety), and many described unmet needs around symptom management. Few had ever utilized PC or pain management services, and most relied primarily on family, friends, and faith communities to help them manage burdensome symptoms. Barriers included lack of familiarity with PC, limited access and financial concerns. Older adults were largely unfamiliar with PC, and many described unmet needs and desire for help with symptom burden. Findings support the need to further explore community-level and cultural barriers to PC among diverse, underserved older adults. Development of innovative community partnerships may help raise awareness of PC and address the physical and psychosocial-spiritual challenges facing chronically-ill minority older adults and their families.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Área Carente de Assistência Médica , Cuidados Paliativos , Serviços Urbanos de Saúde , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Masculino , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde
6.
Artigo em Inglês | MEDLINE | ID: mdl-31878235

RESUMO

A global report found that the quality of dying in Hong Kong lagged behind that of other high-income economies. This study aims to examine the service gaps by conducting a qualitative exploratory study from multiple stakeholders' perspectives. Purposive and snowball sampling strategies were used to maximize variation in the sample. We interviewed 131 participants, including patients, family members, health care providers, administrators, lawyers, and policy makers. The situation analysis helped identify the facilitators and barriers at individual, organizational, and socio-cultural levels that affect service development. Findings showed that awareness on palliative and end-of-life care is growing, but the existing care is limited in terms of acceptability, coverage, variation in practices, continuity, and sustainability. A number of policy, economic, socio-cultural, environmental, and legal factors were also found to hinder service development. Findings of this study demonstrated that the development of palliative and end-of-life care services involved a paradigm shift relating to society as a whole. The overarching theme is to formulate a government-led policy framework. Furthermore, a public health approach has been advocated to create a supportive environment for service development.


Assuntos
Atitude Frente a Morte , Atitude Frente a Saúde , Família/psicologia , Pessoal de Saúde/psicologia , Cuidados Paliativos/psicologia , Pacientes/psicologia , Assistência Terminal/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Política de Saúde , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
7.
BMC Palliat Care ; 18(1): 114, 2019 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-31835998

RESUMO

BACKGROUND: Telehealth is growing and its application in palliative care is seen as a solution to pressures on palliative care services. A 2010 UK review reported growing awareness of telehealth in palliative care but a lack of evidence-based research to support its use. The primary aim of this review was to describe the current use of telehealth in palliative care in the UK and evaluate telehealth initiatives against a digital service standard. The secondary aim was to explore whether telehealth results in a reduction in emergency care access. METHODS: Systematic review of the literature with thematic synthesis. Records were screened and data extracted by two reviewers. EMBASE, MEDLINE, CINAHL, Psychinfo and Cochrane central register for controlled trials were searched using pre-defined terms. Hand searching of conference literature, thesis databases and citation tracking was also conducted. The protocol for this systematic review was registered with PROSPERO and can be found at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080038. RESULTS: The search identified 3807 titles and 30 studies were included in the review. Telehealth was used to support patients and carers, electronic record keeping and professional education. Notably, the number of home telemonitoring initiatives for patients had increased from the 2010 review. Despite this variety, many studies were small scale, descriptive and provided little evidence of evaluation of the service. Ten papers were sufficiently detailed to allow appraisal against the digital service standard and only one of these met all of the criteria to some extent. Seven studies made reference to emergency care access. CONCLUSIONS: Although there is growth of telehealth services, there remains a lack of evaluation and robust study design meaning conclusions regarding the clinical application of telehealth in palliative care cannot be drawn. There is insufficient evidence to appreciate any benefit of telehealth on access to emergency care. Future work is needed to evaluate the use of telehealth in palliative care and improve telehealth design in line with digital service standards.


Assuntos
Cuidados Paliativos/normas , Telemedicina/métodos , Humanos , Cuidados Paliativos/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Telemedicina/normas , Telemedicina/estatística & dados numéricos , Reino Unido
8.
Health Res Policy Syst ; 17(1): 100, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842886

RESUMO

The importance of linking evidence into practice and policy is recognised as a key pillar of a prudent approach to healthcare; it is of importance to healthcare professionals and decision-makers across the world in every speciality. However, rapid access to evidence to support service redesign, or to change practice at pace, is challenging. This is particularly so in smaller specialties such as Palliative Care, where pressured multidisciplinary clinicians lack time and skill sets to locate and appraise the literature relevant to a particular area. Therefore, we have initiated the Palliative Care Evidence Review Service (PaCERS), a knowledge transfer partnership through which we have developed a clear methodology to conduct evidence reviews to support professionals and other decision-makers working in palliative care.PaCERS methodology utilises modified systematic review methods as there is no agreed definition or an accepted methodology for conducting rapid reviews. This paper describes the stages involved based on our iterative recent experiences and engagement with stakeholders, who are the potential beneficiaries of the research. Uniquely, we emphasise the process and opportunities of engagement with the clinical workforce and policy-makers throughout the review, from developing and refining the review question at the start through to the importance of demonstrating impact. We are faced with the challenge of the trade-off between the timely transfer of evidence against the risk of impacting on rigour. To address this issue, we try to ensure transparency throughout the review process. Our methodology aligns with key principles of knowledge synthesis in defining a process that is transparent, robust and improving the efficiency and timeliness of the review.Our reviews are clinically or policy driven and, although we use modified systematic review methods, one of the key differences between published review processes and our review process is in our relationship with the requester. This streamlining approach to synthesising evidence in a timely manner helps to inform decisions faced by clinicians and decision-makers in healthcare settings, supporting, at pace, knowledge transfer and mobilisation.


Assuntos
Comportamento Cooperativo , Medicina Baseada em Evidências/organização & administração , Cuidados Paliativos/organização & administração , Pesquisa Translacional Biomédica/organização & administração , Medicina Baseada em Evidências/normas , Humanos , Cuidados Paliativos/normas , Pesquisa Translacional Biomédica/normas
10.
PLoS One ; 14(12): e0227305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887205

RESUMO

We aimed to demonstrate a single institution experience of treatment of pancreatic ductal carcinoma and to identify the role of radiation therapy. We assessed all patients who were diagnosed with pancreatic ductal carcinoma from January 2011 to December 2017. A total of 342 patients were enrolled. Thirteen, 131, 36, and 162 patients had stage I, II, III, and IV disease, respectively (UICC TNM, 7th edition). Among the patients with stages I-III disease, 94 underwent surgery, and the median overall survival (OS) was 33 months. Of patients with stages I-III disease who were not suitable for surgery, 58 patients received chemotherapy, and the median OS was 12 months. Among them, 17 patients received chemoradiotherapy added on chemotherapy and their OS was significantly better than that of patients who received chemotherapy alone. Of patients with stage IV disease, 111 received chemotherapy, and the median OS was 6 months. This study evaluated the demand, role, and outcome of each treatment modality and demonstrated a single institution experience of treatment of pancreatic ductal carcinoma. The demand and role of radiation therapy remained small; however, radiation therapy might have some importance as a local treatment.


Assuntos
Carcinoma Ductal Pancreático/terapia , Quimiorradioterapia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Neoplasias Pancreáticas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pancreatectomia/estatística & dados numéricos , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Radioterapia Adjuvante/estatística & dados numéricos , Taxa de Sobrevida , Resultado do Tratamento
11.
BMC Palliat Care ; 18(1): 118, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881958

RESUMO

BACKGROUND: Early identification of palliative patients is challenging. The Surprise Question (SQ1; Would I be surprised if this patient were to die within 12 months?) is widely used to identify palliative patients. However, its predictive value is low. Therefore, we added a second question (SQ2) to SQ1: 'Would I be surprised if this patient is still alive after 12 months?' We studied the accuracy of this double surprise question (DSQ) in a general practice. METHODS: We performed a prospective cohort study with retrospective medical record review in a general practice in the eastern part of the Netherlands. Two general practitioners (GPs) answered both questions for all 292 patients aged ≥75 years (mean age 84 years). Primary outcome was 1-year death, secondary outcomes were aspects of palliative care. RESULTS: SQ1 was answered with 'no' for 161/292 patients. Of these, SQ2 was answered with 'yes' in 22 patients. Within 12 months 26 patients died, of whom 24 had been identified with SQ1 (sensitivity: 92%, specificity: 49%). Ten of them were also identified with SQ2 (sensitivity: 42%, specificity: 91%). The latter group had more contacts with their GP and more palliative care aspects were discussed. CONCLUSIONS: The DSQ appears a feasible and easy applicable screening tool in general practice. It is highly effective in predicting patients in high need for palliative care and using it helps to discriminate between patients with different life expectancies and palliative care needs. Further research is necessary to confirm the findings of this study.


Assuntos
Programas de Rastreamento/métodos , Cuidados Paliativos/psicologia , Prognóstico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Países Baixos , Cuidados Paliativos/métodos , Estudos Prospectivos , Inquéritos e Questionários , Revelação da Verdade
12.
JAMA ; 322(24): 2385-2386, 2019 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-31860050
13.
Implement Sci ; 14(1): 107, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856882

RESUMO

BACKGROUND: The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS: The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS: The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS: The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. TRIAL REGISTRATION: The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.


Assuntos
Implementação de Plano de Saúde/métodos , Casas de Saúde/normas , Cuidados Paliativos/métodos , Avaliação de Processos em Cuidados de Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Melhoria de Qualidade , Análise por Conglomerados , Europa (Continente) , Humanos , Assistência de Longa Duração
14.
Medwave ; 19(11): e7730, 2019 Nov 26.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31821319

RESUMO

INTRODUCTION: Despite multiple advances in medicine, gallbladder cancer remains a disease with poor prognosis. In advanced stages, the main options are surgical management or palliative non-surgical care. However, it is not clear which therapy constitutes a better alternative. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified one systematic review including three primary studies, none of them randomized. We concluded that resective surgery may increase survival rates in patients with advanced gallbladder cancer, but the certainty of the evidence is low.


INTRODUCCIÓN: A pesar de los múltiples avances de la medicina, el cáncer de vesícula sigue siendo una enfermedad con mal pronóstico. En su etapa avanzada, se plantea el tratamiento quirúrgico o paliativo no quirúrgico, pero no está claro cual de las alternativas constituye una mejor opción. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos sólo una revisión sistemática que incluyó tres estudios primarios, de los cuales ninguno corresponde a un ensayo aleatorizado. Concluimos que la cirugía resectiva podría aumentar la sobrevida en los pacientes con cáncer de vesícula avanzado, pero la certeza de la evidencia es baja.


Assuntos
Neoplasias da Vesícula Biliar/terapia , Cuidados Paliativos/métodos , Bases de Dados Factuais , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Estadiamento de Neoplasias , Prognóstico , Taxa de Sobrevida , Resultado do Tratamento
15.
Br J Hosp Med (Lond) ; 80(12): C184-C189, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31822173

RESUMO

Palliative and end of life care forms an important part of the role of any doctor in training, and an awareness of a structured approach to managing common symptoms and end of life care is essential. Common symptoms include pain, nausea and vomiting, constipation, and breathlessness. Anticipatory prescribing of the 4 A's (analgesic, anti-emetic, anxiolytic, and anti-secretory) is a proactive approach to ensure medication is available, if required, for common symptoms in the last hours to days of life, such as pain, upper airway secretions, anxiety, and agitation. Prescribing or medication errors in relation to symptom control in palliative care can relate to individual errors, poor communication, poor care coordination, equipment and care planning. There are some important key points relating to prescribing to consider, for example, using recognized conversions when changing between opioids and from the oral to syringe drivers route; that diamorphine and morphine are not equipotent; prescribing liquid opioids in milligrams not millilitres where there are multiple concentrations available; making the indication for steroids clear when used, as they are multiple possible indications (and also their intended duration, to avoid unintended longer term sequelae of steroid use); and avoiding the use of oxygen for symptomatic relief of breathlessness in the absence of hypoxia.


Assuntos
Cuidados Paliativos/organização & administração , Assistência Terminal/organização & administração , Corticosteroides/uso terapêutico , Analgésicos/uso terapêutico , Ansiolíticos/uso terapêutico , Antieméticos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Desprescrições , Dispneia/tratamento farmacológico , Humanos , Náusea/prevenção & controle , Manejo da Dor/métodos , Cuidados Paliativos/normas , Assistência Terminal/normas , Vômito/prevenção & controle
16.
Fam Syst Health ; 37(4): 342-343, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31815515

RESUMO

This article details the hospitalization experience of a homeless man diagnosed with cancer. Recounted are the man's desire to enter a hospice program and his need for a safe space. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Cuidados Paliativos/métodos , Relações Médico-Paciente , Apoio Social , Banheiros , Idoso , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/psicologia , Masculino , Cuidados Paliativos/psicologia , Classe Social
17.
Trials ; 20(1): 713, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829237

RESUMO

BACKGROUND: In medical oncology settings, early specialist palliative care interventions have demonstrated improvements in patient quality of life and survival compared with usual oncologic care. However, the effect of early specialist palliative care interventions in surgical oncology settings is not well studied. METHODS: The Surgery for Cancer with Option for Palliative Care Expert (SCOPE) Trial is a single-center, prospective, single-blind, randomized controlled trial of a specialist palliative care intervention for cancer patients undergoing non-palliative surgery. It will enroll 236 patients scheduled for major abdominal operations for malignancy, who will be randomized 1:1 at enrollment to receive usual care (control arm) or specialist palliative care consultation (intervention arm). Intervention arm patients will receive consultations from a palliative care specialist (physician or nurse practitioner) preoperatively and postoperatively. The primary outcome is physical and functional wellbeing at 90 days postoperatively. Secondary outcomes are quality of life at 90 days postoperatively, posttraumatic stress disorder symptoms at 180 days postoperatively, days alive at home without an emergency room visit in the first 90 postoperative days, and overall survival at 1 year postoperatively. Participants will be followed for 3 years after surgery for exploratory analyses of their ongoing quality of life, healthcare utilization, and mortality. DISCUSSION: SCOPE is an ongoing randomized controlled trial evaluating specialist palliative care interventions for cancer patients undergoing non-palliative oncologic surgery. Findings from the study will inform ways to identify and improve care of surgical patients who will likely benefit from specialist palliative care services. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03436290 First Registered: 16 February 2018 Enrollment Began: 1 March 2018 Last Update: 20 December 2018.


Assuntos
Cistectomia , Procedimentos Cirúrgicos de Citorredução , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias/cirurgia , Cuidados Paliativos , Assistência Perioperatória , Cistectomia/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Neoplasias/diagnóstico , Neoplasias/psicologia , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Tennessee , Fatores de Tempo , Resultado do Tratamento
18.
Artigo em Inglês | MEDLINE | ID: mdl-31817435

RESUMO

Introduction: Quality medical education, centered on a patient's needs, is crucial to develop the health professionals that our society requires. Research suggests a strong contribution of palliative care education to professionalism. The aim of this study was to design and validate a self-report inventory to measure student's professional development. Method: Sequential exploratory strategy mixed method. The inventory is built based on the themes that emerged from the analysis of four qualitative studies about nursing and medical students' perceptions related to palliative care teaching interventions (see Ballesteros et al. 2014, Centeno et al. 2014 and 2017, Rojí et al. 2017). The structure and psychometrics of the inventory obtained is tested in two different surveys with two different groups of medical students. Inventory reliability and construct validity are tested in the first survey group. To verify the inventory structure, a confirmatory factor analysis is performed in a second survey group. Results: The inventory has 33 items and seven dimensions: a holistic approach, caring for and understanding the patient, personal growth, teamwork, decision-making, patient evaluation, and being a health care professional. Cronbach's-alpha was 0.73-0.84 in all seven domains, ICC: 0.95. The confirmatory factor analysis comparative fit index (CFI) was 1 with a standardized root mean square Index 0.088 (SRMR) and obtained a 0.99 goodness-of-fit R-square coefficient. Conclusions: this new inventory is grounded on student's palliative care teaching experiences and seems to be valid to assess student's professional development.


Assuntos
Atitude do Pessoal de Saúde , Educação de Graduação em Medicina/organização & administração , Cuidados Paliativos , Profissionalismo , Estudantes de Medicina , Adulto , Análise Fatorial , Feminino , Pessoal de Saúde , Humanos , Masculino , Psicometria , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Inquéritos e Questionários
19.
BMC Palliat Care ; 18(1): 111, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31818281

RESUMO

BACKGROUND: Grieving relatives can suffer from numerous consequences like anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, and prolonged grief. This study aims to assess the psychological consequences of grieving relatives after patients' death in French palliative care units and their needs for support. METHODS: This is a prospective observational multicenter mixed study. Relatives of adult patients with a neoplasia expected to be hospitalized more than 72 h in a palliative care unit for end-of-life issues will be included within 48 h after patient admission. End-of-life issues are defined by the physician at patient admission. Relatives who are not able to have a phone call at 6-months are excluded. The primary outcome is the incidence of prolonged grief reaction defined by an ICG (Inventory Complicate Grief) > 25 (0 best-76 worst) at 6 months after patient' death. Prespecified secondary outcomes are the risk factors of prolonged grief, anxiety and depression symptoms between day 3 and day 5 and at 6 months after patients' death based on an Hospital Anxiety and Depression score (range 0-42) > 8 for each subscale (minimal clinically important difference: 2.5), post-traumatic stress disorder symptoms 6 months after patient' death based on the Impact of Events Scale questionnaire (0 best-88 worst) score > 22, experience of relatives during palliative care based on the Fami-Life questionnaire, specifically built for the study. Between 6 and 12 months after the patient's death, a phone interview with relatives with prolonged grief reactions will be planned by a psychologist to understand the complex system of grief. It will be analyzed with the Interpretative Phenomenological Analysis. We planned to enroll 500 patients and their close relatives assuming a 25% prolonged grief rate and a 6-month follow-up available in 60% of relatives. DISCUSSION: This study will be the first to report the psychological consequences of French relatives after a loss of a loved one in palliative care units. Evaluating relatives' experiences can provide instrumental insights for means of improving support for relatives and evaluation of bereavement programs. TRIAL REGISTRATION: NCT03748225 registered on 11/19/2018. Recruiting patients.


Assuntos
Família/psicologia , Pesar , Cuidados Paliativos/psicologia , Protocolos Clínicos , França , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/tendências , Estudos Prospectivos , Inquéritos e Questionários
20.
United European Gastroenterol J ; 7(10): 1380-1388, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31839964

RESUMO

Background: As small-bowel adenocarcinoma (SBA) is scarce, no standard systemic regimen in metastatic disease has been defined. Objective: To obtain insights into the use and effects of palliative chemotherapy in patients with metastatic SBA in a population-based setting. Methods: Data from the Netherlands Cancer Registry of patients with metastatic SBA between 2007 and 2016 were used (n = 522). For patients treated with palliative chemotherapy, differences in treatment regimens and survival were evaluated. Results: Palliative chemotherapy was received by 38% of patients (n = 199). First-line combination chemotherapy was administered to 80% of patients, mainly CAPOX/FOLFOX. Single-agent chemotherapy mostly consisted of capecitabine. Second-line treatment, mostly irinotecan-based (58%), was prescribed to 27% of patients. Age 70 years or older was an adverse predictive factor for receiving first-line combination chemotherapy (odds ratio (OR) 0.2, 95% confidence interval (CI) 0.08-0.62) and second-line therapy (OR 0.3, 95% CI 0.10-0.72). Median overall survival with palliative chemotherapy was 9.3 months, compared with 3.0 months without. In subanalyses, patients who received only first-line treatment had a median overall survival of 5.6 and 7.0 months after single-agent and combination chemotherapy, respectively. Conclusion: A minority of patients were treated with palliative chemotherapy. First-line treatment consisted predominantly of oxaliplatin-based combination chemotherapy, whereas second-line treatment was mainly irinotecan-based. Population-based median overall survival for selected patients treated with chemotherapy amounted to nine months.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/tratamento farmacológico , Intestino Delgado/patologia , Cuidados Paliativos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Humanos , Neoplasias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Países Baixos/epidemiologia , Razão de Chances , Cuidados Paliativos/métodos , Prognóstico , Sistema de Registros
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