P211 Social Disparities and Symptom Burden in Palliative Care Populations: Insights and Clinical Strategies from the Perspective of Palliative Care Providers

Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses) perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

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Symptom burden and distress in patients with cancer in Africa.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.255 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 255-255

Author(s):

John K. Weru

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Symptom Burden ◽

Public Health Problem ◽

Symptom Assessment ◽

University Hospital ◽

Care Providers ◽

Patients With Cancer ◽

Edmonton Symptom Assessment Scale

255 Background: Cancer has become a significant public health problem in Africa but still most diagnoses are made late, Sitas et al (2006). The need for palliative care is significant due to the late contact with health care providers and the many symptoms they present with. No study has been undertaken to assess symptomatology for these patients in Africa. Objective: To study the prevalence of symptoms in patients with cancer in an African setting. Methods: Symptom studies from records of patients with cancer referred to the Palliative Care Services at the Aga Khan University Hospital, Nairobi in 6 months. Symptoms charted on Edmonton Symptom Assessment Scale. Results: 42 patients were referred to the service in this period. All the patients reported > 3 symptoms which cut across the physical, social, psychological and spiritual concerns. The most common symptoms were pain in the physical dimension (90%) as reported by the patient. Fatigue was reported by (93%).Family wellbeing was the main worry in psychological dimension (95%). 94 % reported social disconnect due to the diagnosis, job losses and huge cost of health care. 96% suffered from the existential question of why me and worry about the future. Conclusions: Cancer has become a major burden to patients, families, societies and nations in Africa. Patients suffering from this illness experience a myriad of symptoms which require holistic approach to care. Social wellbeing remains a major concern for patients with cancer in Africa.

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The Case for Dual Training in Geriatric Medicine and Palliative Care: The Time is Now

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117696251 ◽

2017 ◽

Vol 35 (2) ◽

pp. 364-370

Author(s):

Jennifer Gabbard ◽

Matthew McNabney

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Quality Care ◽

Geriatric Medicine ◽

Symptom Burden ◽

Aging Population ◽

Chronic Illnesses ◽

Care Providers ◽

Care Needs

The majority of older adults die from chronic illnesses which are preceded by years of progressive decline and increasing symptom burden. Delivery of high-quality care cannot take place without sufficient numbers of health professionals with appropriate training and skills in both geriatric and palliative care medicine. Despite the surge in aging population and the majority of deaths being attributed to patients with multiple comorbidities, very few health-care providers undergo dual training in these areas. Thus, the nation is facing a health-care crisis as the number of geriatric patients with chronic disease increasingly outpaces the number of physicians with adequate skills to manage them. Joint training in palliative care and geriatric medicine could prepare physicians to better manage our aging population by addressing all their health-care needs irrespective of their stage of disease emphasizing patient-directed care.

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Improving the Care of Patients With Serious Illness: What Are the Palliative Care Education Needs of Internal Medicine Residents?

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120987207 ◽

2021 ◽

pp. 104990912098720

Author(s):

Julia L. Frydman ◽

Kevin Hauck ◽

Joseph Lowy ◽

Laura P. Gelfman

Keyword(s):

Internal Medicine ◽

Palliative Care ◽

Medical Center ◽

Academic Medical Center ◽

Symptom Burden ◽

Care Providers ◽

Knowledge Gaps ◽

Serious Illness ◽

Code Status ◽

Academic Medical

Background: Hospitalized patients with serious illness have significant symptom burden and face complex medical decisions that often require goals of care discussions. Given the shortage of specialty palliative care providers, there is a pressing need to improve the palliative care skills of internal medicine (IM) residents, who have a central role in the care of seriously ill patients hospitalized at academic medical centers. Methods: We conducted an anonymous survey of IM residents at a large, urban, academic medical center to identify which aspects of palliative care trainees find most important and their knowledge gaps in palliative care. The survey measured trainees’ self-assessed degree of importance and knowledge of core palliative care skills and evaluated frequency of completing advance care planning documentation. Results: Overall, 51 (23%) IM residents completed the survey. The majority of trainees considered multiple palliative care skills to be “very important/important”: symptom management, prognostication, introducing the palliative care approach, discussing code status, and breaking serious news. Across these same skills, trainees reported variable levels of knowledge. In our sample, trainees reported completing healthcare proxy forms and Medical Orders for Life-Sustaining Treatment infrequently. Conclusions: IM trainees rated core palliative care skills as important to their practice. Yet, they reported knowledge gaps across multiple core palliative care skills that should be addressed given their role as frontline providers for patients with serious illness.

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Faculty Opinions recommendation of Perspectives on Palliative Care in Cancer Clinical Trials: Diverse Meanings from Multidisciplinary Cancer Care Providers.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732630932.793545980 ◽

2018 ◽

Author(s):

Betty Ferrell

Keyword(s):

Palliative Care ◽

Clinical Trials ◽

Cancer Care ◽

Cancer Clinical Trials ◽

Care Providers

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What makes palliative care needs “complex”? A multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

BMC Palliative Care ◽

10.1186/s12904-020-00700-3 ◽

2021 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Anne M. Finucane ◽

Connie Swenson ◽

John I. MacArtney ◽

Rachel Perry ◽

Hazel Lamberton ◽

...

Keyword(s):

Palliative Care ◽

Focus Groups ◽

Healthcare Professionals ◽

Psychological Needs ◽

Care Providers ◽

Specialist Palliative Care ◽

Care Needs ◽

Complex Needs ◽

Sequential Explanatory ◽

Palliative Care Needs

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.

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The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

Palliative Medicine ◽

10.1177/0269216321994728 ◽

2021 ◽

pp. 026921632199472

Author(s):

Natalia Salamanca-Balen ◽

Thomas V Merluzzi ◽

Man Chen

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Palliative Care ◽

Meta Analysis ◽

Symptom Burden ◽

Well Being ◽

Medium Effect ◽

Spiritual Well Being ◽

Quasi Experimental

Background: The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases. Aim: To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome. Design: This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956). Data sources: Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies. Results: Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size ( g = 0.61, 95% confidence interval (CI) = 0.28–0.93) but did not significantly reduce hopelessness ( g = −0.08, 95% CI = −0.18 to 0.02). It was found that interventions significantly increase spirituality ( g = 0.70, 95% CI = 0.02–1.37) and decrease depression ( g = −0.29, 95% CI = −0.51 to −0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low. Conclusions: Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

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How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

BMJ Open ◽

10.1136/bmjopen-2020-041214 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041214

Author(s):

Kevin Glynn ◽

Frank McKenna ◽

Kevin Lally ◽

Muireann O’Donnell ◽

Sandeep Grover ◽

...

Keyword(s):

Palliative Care ◽

Rating Scale ◽

Symptom Burden ◽

Systemic Infection ◽

International Study ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Liaison Psychiatry ◽

Cross Sectional ◽

Hypoactive Delirium

ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

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Concerns of Patients With Cancer on Accessing Cannabis Products in a State With Restrictive Medical Marijuana Laws: A Survey Study

Journal of Oncology Practice ◽

10.1200/jop.19.00184 ◽

2019 ◽

Vol 15 (10) ◽

pp. 531-538 ◽

Cited By ~ 2

Author(s):

Vinita Singh ◽

Ali J. Zarrabi ◽

Kimberly A. Curseen ◽

Roman Sniecinski ◽

Justine W. Welsh ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

Health Care Providers ◽

Medical Marijuana ◽

Survey Study ◽

Care Practice ◽

Care Providers ◽

Patients With Cancer ◽

Medical Marijuana Laws ◽

Source Of Information

PURPOSE: Several states, particularly in the Southeast, have restrictive medical marijuana laws that permit qualified patients to use specific cannabis products. The majority of these states, however, do not provide avenues for accessing cannabis products such as in-state dispensaries. METHODS: We conducted a survey of patients registered for medical marijuana (low tetrahydrocannabinol [THC] oil cards) in an ambulatory palliative care practice in Georgia (one of the states with restrictive medical marijuana laws). RESULTS: We had a total of 101 responses. Among our sample of patients who use cannabis as part of a state-approved low THC oil program, 56% were male and 64% were older than age 50 years. Advanced cancer was the most common reason (76%) for granting the patients access to a low THC oil card. Although patients reported cannabis products as being extremely helpful for reducing pain, they expressed considerable concerns about the legality issues (64%) and ability to obtain THC (68%). Several respondents were using unapproved formulations of cannabis products. For 48% of the patients, their physician was the source of information regarding marijuana-related products. Furthermore, they believed that their health care providers and family members were supportive of their use of cannabis (62% and 79%, respectively). CONCLUSION: Patients on Georgia’s medical marijuana program are most concerned about the legality of the product and their ability to obtain marijuana-related products. Therefore, we recommend that states with medical marijuana laws should provide safe and reliable access to cannabis products for qualifying patients.

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