283 Psychological consequences of pain in home care advanced cancer patients

Abstract Background: To support the early integration of palliative home care (PHC) in cancer treatment, we developed the EPHECT intervention and pilot tested it with 30 advanced cancer patients in Belgium using a pre post design with no control group. We aim to determine the feasibility, acceptability and perceived effectiveness of the EPHECT intervention.Methods: Interviews with patients (n=16 of which 11 dyadic with family caregivers), oncologists and GPs (n=11) and a focus group with the PHC team. We further analyzed the study materials and logbooks of the PHC team (n=8). Preliminary effectiveness was assessed with questionnaires EORTC QLQ C-30, HADS and FAMCARE and were filled in at baseline and 12, 18 and 24 weeks.Results: In the interviews after the intervention period, patients reported feelings of safety and control and an optimized quality of life. The PHC team could focus on more than symptom management because they were introduced earlier in the trajectory of the patient. Telephone-based contact appeared to be insufficient to support interprofessional collaboration. Furthermore, some family caregivers reported that the nurse of the PHC team was focused little on them.Conclusion: Nurses of PHC teams are able to deliver early palliative care to advanced cancer patients. However, more attention needs to be given to family caregivers as caregiver and client. Furthermore, the home visits by the PHC team have to be further evaluated and adapted. Lastly, professionals have to find a more efficient way to discuss future care.

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Barriers for the Early Integration of Palliative Home Care Into the Disease Trajectory of Advanced Cancer Patients: A Focus Group Study with Palliative Home Care Teams

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.10.017 ◽

2018 ◽

Vol 56 (6) ◽

pp. e25-e26

Author(s):

Naomi Dhollander ◽

Aline De Vleminck ◽

Lenzo Robijn ◽

Luc Deliens ◽

Simon Van Belle ◽

...

Keyword(s):

Focus Group ◽

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Focus Group Study ◽

Palliative Home Care ◽

Early Integration ◽

Disease Trajectory

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The Importance of a Home Care Program for Patients with Advanced Cancer Pain

Tumori Journal ◽

10.1177/030089168507100506 ◽

1985 ◽

Vol 71 (5) ◽

pp. 449-454 ◽

Cited By ~ 30

Author(s):

Vittorio Ventafridda ◽

Marcello Tamburini ◽

Silvana Selmi ◽

Luigi Valera ◽

Franco De Conno

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Performance Status ◽

Care Program ◽

Pain Clinic ◽

Advanced Cancer Patients ◽

Sample Group ◽

Significant Difference ◽

Quality Of Life Index

At the Pain Clinic of the National Cancer Institute of Milan, a special Home Care Program has been set up to assist advanced cancer patients with pain and their families during their remaining survival. The Home Care Unit comprises a team of physicians, nurse clinicians, psychologists and many volunteers who are active both in the hospital and at the patient's home. This entire operation provides a continuous relationship between the family, the patient and the Home Care Unit. This Home Care Program, which is one of a kind with other forms of treatment for advanced cancer patients (i.e. hospices), has produced interesting results. Out of a sample group of 50 patients, 33 were monitored at home by the Home Care Unit while 17 had their families to do the monitoring. Over a six-week period the following results were reported: a) Improvement of psycho-emotional factors such as anxiety, weakness and mood for both patients and their families who entered the Home Care Program. b) The Quality of Life Index remained unchanged for the sample group that entered the Home Care Program whereas it deteriorated for patients monitored by their families. c) A decrease in the Integrated Pain Score for both groups; however, results showed a statistically significant difference in favor of patients on the Home Care Program. d) The Performance Status decreased by very little over the study period, and there was little difference between the two groups. These results confirm the need for a Home Care Program which must go hand in hand with the Pain Clinic as an effective way to control Total Pain.

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Home Care for Advanced and Very Advanced Cancer Patients: The Bologna Experience

Journal of Palliative Care ◽

10.1177/082585978800400309 ◽

1988 ◽

Vol 4 (3) ◽

pp. 54-57 ◽

Cited By ~ 12

Author(s):

Franco Pannuti

Keyword(s):

Home Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients

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Chronic conditions among advanced cancer patients and their spouse caregivers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.20 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 20-20

Author(s):

Dana Ketcher ◽

Amy Otto ◽

Maija Reblin

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Chronic Conditions ◽

Well Being ◽

Medical Decision ◽

Depression Symptoms ◽

Multiple Chronic Conditions ◽

Psychological Consequences ◽

Advanced Cancer Patients ◽

Spouse Caregivers

20 Background: Chronic conditions and multimorbidity have been recognized to have negative impacts on costs of healthcare, quality of care, and well-being. The interdependence of patients and caregivers has also been highlighted, in that patient factors can impact caregiver outcomes and vice versa. Yet little research has been conducted on how the number of other health conditions among spouse caregivers (CGs) and advanced cancer patients impact their own and their partners’ well-being. Methods: Data were gathered as part of a prospective observational study of couples coping with advanced cancer. Patients had to have a cohabiting spouse/partner who identified as providing some care and also agreed to participate. Results: Patients rated their overall health slightly worse (scale 1-5, M = 2.85, SD = 0.95) than CGs ( M = 2.27, SD = 0.75). Patients also reported more total conditions ( M = 2.59, SD = 1.42) than CGs ( M = 1.4, SD = 1.14). Most patients (81%) reported at least one chronic condition other than cancer (44% of patients reported at least two other conditions); the most common conditions among patients were hypertension (43%), lung disease (36%), arthritis, and diabetes (both 24%). About 23% of CGs reported having no chronic conditions; 36% reported at least one and 41% reported at least two. The most common conditions among CGs were arthritis (40%), hypertension (39%), and heart disease, diabetes, and cancer (13% each). A greater number of CG conditions predicted greater depression symptoms in the patient ( B = 0.60, p = .040), controlling for patient conditions. More conditions among patients was a significant predictor of less patient social support ( B = -0.67, p = .017) and a marginally-significant predictor of greater perceived stress among caregivers ( B = -0.27, p = .064). A history of CG cancer predicted greater depression symptoms in the patient ( B = 2.3, p = .02). Conclusions: Chronic conditions and multimorbidity can have significant psychological consequences for both patient and CG. Clinicians, in addition to making an active effort to incorporate CGs into medical decision making and treatment planning, should also be aware of patient and caregiver multiple chronic conditions in order to provide more holistic care for patients.

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