scholarly journals “Truly holistic?” Differences in documenting physical and psychosocial needs and hope in Portuguese palliative patients

2020 ◽  
pp. 1-6
Author(s):  
Miguel Julião ◽  
Maria Ana Sobral ◽  
Paula Calçada ◽  
Bárbara Antunes ◽  
Baltazar Nunes ◽  
...  
Keyword(s):  
Life Experience ◽  
Performance Status ◽  
Descriptive Analysis ◽  
Symptom Assessment ◽  
Well Being ◽  
Shortness Of Breath ◽  
Psychosocial Needs ◽  
Edmonton Symptom Assessment Scale ◽  
Will To Live ◽  
Symptom Assessment Scale

Abstract Objective Palliative care (PC) aims to improve patients' and families' quality of life through an approach that relieves physical, psychosocial, and spiritual suffering, although the latter continues to be under-assessed and under-treated. This study aimed to describe the prevalence of physical, psychosocial, and hope assessments documented by a PC team in the first PC consultation. Method The retrospective descriptive analysis of all first PC consultations registered in our anonymized database (December 2018–January 2020), searching for written documentation regarding (1) Edmonton Symptom Assessment Scale (ESAS) physical subscale (pain, tiredness, nausea, drowsiness, appetite, shortness of breath, constipation, insomnia, and well-being), (2) the single question “Are you depressed?” (SQD), (3) the question “Do you feel anxious?” (SQA), (4) feeling a burden, (5) hope-related concerns, (6) the dignity question (DQ), and (7) will to live (WtL). Results Of the 174 total of patients anonymously registered in our database, 141 PC home patients were considered for analysis; 63% were male, average age was 70 years, the majority had malignancies (82%), with a mean performance status of 52%. Evidence of written documentation was (1) ESAS pain (96%), tiredness (89%), nausea (89%), drowsiness (79%), appetite (89%), shortness of breath (82%), constipation (74%), insomnia (72%), and well-being (52%); (2) the SQD (39%); (3) the SQA (11%); (4) burden (26%); (5) hope (11%); (6) the DQ (33%); and (7) WtL (33%). Significant differences were found between the frequencies of all documented items of the ESAS physical subscale (29%), and all documented psychosocial items (SQD + SQA + burden + DQ) (1%), hope (11%), and WtL (33%) (p = 0.0000; p = 0.0005; p = 0.0181, respectively). Significance of results There were differences between documentation of psychosocial, hope, and physical assessments after the first PC consultation, with the latter being much more frequent. Further research using multicenter data is now required to help identify barriers in assessing and documenting non-physical domains of end-of-life experience.

scholarly journals The desire for death in Portuguese home-care palliative patients: Retrospective analysis of the prevalence and associated factors

2020 ◽  
pp. 1-7
Author(s):  
Miguel Julião ◽  
Maria Ana Sobral ◽  
Paula Calçada ◽  
Bárbara Antunes ◽  
Daniela Runa ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Life Experience ◽  
Performance Status ◽  
Symptom Assessment ◽  
Well Being ◽  
Living Will ◽  
Advanced Directives ◽  
Edmonton Symptom Assessment Scale ◽  
Desire For Death

Abstract Objective Desire for death (DfD) is a complex and multifactorial dimension of end-of-life experience. We aimed to evaluate the prevalence of DfD and its associations, arising within the setting of a tertiary home-based palliative care (PC) unit. Method Retrospective analysis of all DfD entries registered in our anonymized database from October 2018 to April 2020. Results Of the 163 patients anonymously registered in our database, 122 met entry criteria; 52% were male, the average age was 69 years old; 85% had malignancies, with a mean performance status (PPS) of 56%. The prevalence of DfD was 20%. No statistical differences were observed between patients with and without DfD regarding sex, age, marital status, religion, social support, prior PC or psychological follow-up, type of diagnosis, presence of advanced directives/living will, time since diagnosis and PC team's follow-up time. Statistically significant associations were found between higher PPS scores and DfD (OR = 0.96; 95% confidence interval (CI) [0.93–0.99]); Edmonton Symptom Assessment Scale scores for drowsiness (OR = 4.05; 95% CI [1.42–11.57]), shortness of breath (OR = 3.35; 95% CI [1.09–10.31]), well-being (OR = 7.64; 95% CI [1.63–35.81]). DfD was associated with being depressed (OR = 19.24; 95% CI [3.09–+inf]); feeling anxious (OR = 11.11; 95% CI [2.51–49.29]); HADS anxiety subscale ≥11 (OR = 25.0; 95% CI [2.10–298.29]); will-to-live (OR = 39.53; 95% CI [4.85–321.96]). Patients feeling a burden were more likely to desire death (OR = 14.67; 95% CI [1.85–116.17]), as well as those who were not adapted to the disease (OR = 4.08; 95% CI [1.30–12.84]). In multivariate regression analyses predicting DfD, three independent factors emerged: higher PPS scores were associated with no DfD (aOR = 0.95; 95% CI [0.91–0.99]), while the sense of being a burden (aOR = 12.82; 95% CI [1.31–125.16]) and worse well-being (aOR = 7.72; 95% CI [1.26–47.38]) predicted DfD. Significance of results Prevalence of DfD was 20% and consistent with previous Portuguese evidence on DfD in PC inpatients. Both physical and psychosocial factors contribute to a stronger DfD.

scholarly journals Patients with advanced cancer and depression report a significantly higher symptom burden than non-depressed patients

2018 ◽  
Vol 17 (2) ◽  
pp. 143-149 ◽  
Author(s):  
Kjersti Støen Grotmol ◽  
Hanne C. Lie ◽  
Jon Håvard Loge ◽  
Nina Aass ◽  
Dagny Faksvåg Haugen ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Well Being ◽  
Edmonton Symptom Assessment Scale ◽  
Patient Health ◽  
Symptom Assessment Scale

AbstractObjectiveClinical observations indicate that patients with advanced cancer and depression report higher symptom burden than nondepressed patients. This is rarely examined empirically. Study aim was to investigate the association between self-reported depression disorder (DD) and symptoms in patients with advanced cancer controlled for prognostic factors.MethodThe sample included 935 patients, mean age 62, 52% males, from an international multicentre observational study (European Palliative Care Research Collaborative – Computerised Symptom Assessment and Classification of Pain, Depression and Physical Function). DD was assessed by the Patient Health Questionnaire-9 and scored with Diagnostic and Statistical Manual of Mental Disorder-5 algorithm for major depressive disorder, excluding somatic symptoms. Symptom burden was assessed by summing scores on somatic Edmonton Symptom Assessment Scale (ESAS) symptoms, excluding depression, anxiety, and well-being. Item-by-item scores and symptom burden of those with and without DD were compared using nonparametric Mann-Whitney U tests. The relative importance of sociodemographic, medical, and prognostic factors and DD in predicting symptom burden was assessed by hierarchical, multiple regression analyses.ResultPatients with DD reported significantly higher scores on ESAS items and a twofold higher symptom burden compared with those without. Factors associated with higher symptom burden were as follows. Diagnosis: lung (β = 0.15, p < 0.001) or breast cancer (β = 0.08, p < 0.05); poorer prognosis: high C-reactive protein (β = 0.08, p < 0.05), lower Karnofsky Performance Status (β = −0.14, p < 0.001), and greater weight loss (β = −0.15, p < 0.001); taking opioids (β = 0.11, p < 0.01); and having DD (β = 0.23, p < 0.001). The full model explained 18% of the variance in symptom burden. DD explained 4.4% over and above that explained by all the other variables.Significance of resultsDepression in patients with advanced cancer is associated with higher symptom burden. These results encourage improved routines for identifying and treating those suffering from depression.

The Effect of Combined Drug Management and an Exercise Program on Symptoms and the Happiness Level in Elderly Women

2020 ◽  
Vol 33 (1) ◽  
pp. 14-20
Author(s):  
Seçil Gülhan Güner ◽  
Arzu Erden ◽  
Nesrin Nural
Keyword(s):  
Elderly Women ◽  
Short Form ◽  
Exercise Program ◽  
Symptom Assessment ◽  
Well Being ◽  
Drug Management ◽  
Edmonton Symptom Assessment Scale ◽  
Post Test ◽  
Symptom Assessment Scale

The aim of this study was to determine the effect of combined drug management and an exercise program on symptoms and the happiness levels of elderly women people living at home. This interventional study included a total of 35 women, aged 65 to 74 years, who were registered at the Family Healthcare Centre. A 14-week program was combined with exercise and drug management. Pre-test and post-test evaluations results were recorded. The Edmonton Symptom Assessment Scale (ESAS), Oxford Happiness Questionnaire-Short Form (OHQ-SF) and a sociodemographic form and Follow-Up form were used for data collection. The mean ESAS points of the symptoms of pain, tiredness, sadness, and insomnia showed a significant decrease after intervention and the sense of well-being improved ( p < .001). A statistically significant increase was determined in the happiness levels of the participants after intervention. The combined program of drug management and exercise was found to be effective in raising happiness levels and reducing symptoms in elderly women.

The Quebec Cannabis Registry: a pharmacovigilance and effectiveness study on the use of medical cannabis in cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12109-12109
Author(s):  
Antonio Vigano ◽  
Michelle Canac-Marquis ◽  
Rihab Gamaoun ◽  
Pierre Beaulieu ◽  
Andrée Neron ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Repeated Measures ◽  
Brief Pain Inventory ◽  
Symptom Assessment ◽  
Well Being ◽  
Population Based ◽  
Pain Severity ◽  
Medical Cannabis ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

12109 Background: The Quebec Cannabis Registry (QCR) was launched in 2015 to allow physicians to prescribe medical cannabis (MC) in the province of Quebec, Canada. This study aimed to investigate the safety and effectiveness of MC in cancer patients using pharmacovigilance data prospectively collected for up to 24 months. Methods: Patients were enrolled in the QCR between May 2015 and October 2018 and followed every 3 months. Study outcomes included adverse events (AE), pain severity and interference (Brief-Pain Inventory), wellbeing (Revised-Edmonton Symptom Assessment Scale) and overall health scale (EQ5D5L) at baseline and at each follow-up (F-UP). Significance of changes over time were assessed using repeated-measures ANOVA. Results: Out of the 2991 patients enrolled in the QCR, 358 (12.8%) were cancer patients (mean age 57.7 (± 14.6); 171 (47.8%) males). The main cancer types were breast (16.2%), lung (11.7%), leukemia (11.5%) and colorectal (11.2%). MC was prescribed primarily for pain (72.1%), anxiety (4.7%), nausea (4.5%), anorexia (3.9%), and insomnia (3.1%). A total of 13 patients (3.6%) reported AE with only three being serious (one unrelated to MC: stroke; and two possibly related: diarrhea, from CBD oil overdose and pneumonia from smoking MC). Mean scores significantly (p < 0.05) improved between baseline and 3 months F-UP for pain severity (4.8 ± 1.5 vs 4.1 ± 1.8), pain interference (4.6 ± 1.8 vs 3.8 ± 1.7), and the overall health scale (60 ± 21 vs 71 ± 18). Well-being scores also significantly improved between baseline and 6 months F-UP (4.4 ± 2.1 vs 3.5 ± 2.8). Conclusions: Population-based data shows that cancer patients can benefit safely and effectively from MC as a complementary treatment, when prescribed and monitored under medical-nursing supervision.

Comfort Level in Caregivers of Palliative Care Patients and Affecting Factors: What Should We Know?

2021 ◽  
pp. 003022282110147
Author(s):  
Kadriye Sayin Kasar ◽  
Yasemin Yildirim ◽  
Ulku Bulut
Keyword(s):  
Palliative Care ◽  
Nursing Care ◽  
Performance Status ◽  
Symptom Assessment ◽  
Comfort Level ◽  
Affecting Factors ◽  
Holistic Nursing ◽  
Care Clinic ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

Caregivers are an important source of support for patients in palliative care. Comfort is an important concept in nursing care for both patients and their families, and nurses aim to increase comfort. The aim of the study was to determine the comfort level and influencing factors in caregivers of palliative care patients. The research sample consisted of 102 caregivers related to palliative care patients. The data were obtained with an Individual Information Form, the Edmonton Symptom Assessment Scale (ESAS) and the End of Life Comfort Scale (Caregiver/Family). The study was conducted in the palliative care clinic of Aksaray University Training and Research Hospital between October 2018 and April 2019. There was a significant relationship between the total comfort score of the caregivers and the patient's performance status, the caregivers' age, their economic situation, the length of the caregiving period and receiving help in care (social support) ( p < 0.05). Providing comfort is an important function and challenge for holistic nursing care, as comfort is a lifelong need in health and disease. Caregivers in the risk group should be aware of this issue and necessary precautions should be taken.

scholarly journals Sexuality and assessment of physical and psychological symptoms of older adults in outpatient care

2021 ◽  
Vol 74 (suppl 2) ◽  
Author(s):  
Natalia Coelho Marques da Silva ◽  
Luana Baldin Storti ◽  
Gabriella Santos Lima ◽  
Renata Karina Reis ◽  
Thaís França de Araújo ◽  
...  
Keyword(s):  
Older Adults ◽  
Sexual Activity ◽  
Psychological Symptoms ◽  
Symptom Assessment ◽  
Well Being ◽  
Sexual Experiences ◽  
Cross Sectional ◽  
Symptom Intensity ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

ABSTRACT Objective: to analyze the relationship between affective and sexual experiences and the intensity of physical and psychological symptoms of older adults. Methods: observational, cross-sectional and analytical study, guided by the STROBE tool, carried out in a geriatric outpatient clinic. Sociodemographic and health questionnaire, Affective and Sexual Experiences Scale for Elderly, Edmonton Symptom Assessment Scale were used. Descriptive statistical analysis and Spearman correlation were performed. Results: forty-five older adults participated, with a mean age of 73.8 years; most (91.1%) were married. The highest averages of symptom intensity were pain (4.9), anxiety (4.8), drowsiness (4.5), and a feeling of well-being (4.5). There was a negative correlation between sadness and the dimensions of sexual activity and affective relationships (rs=-0.365; p=0.014 and rs=-0.386; p=0.009) and between anxiety and sexual activity (rs=-0.308; p=0.040). Conclusion: as sadness increases, affective and sexual experiences are less. The greater the anxiety intensity, the lower the sexual experiences.

Avoidable and unavoidable visits to the emergency department among advanced cancer patients (AdCa) followed by the supportive care (SCPC) outpatient clinic.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 140-140
Author(s):  
Marvin Omar Delgado-Guay ◽  
SeongHoon Shin ◽  
Gary B. Chisholm ◽  
Janet L. Williams ◽  
Julio Allo ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Symptom Assessment ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Phone Calls ◽  
Significant Difference ◽  
Edmonton Symptom Assessment Scale ◽  
Outpatient Center ◽  
Ed Visits ◽  
Symptom Assessment Scale

140 Background: Admissions to ED are considered undesirable for AdCa receiving palliative care. There is limited research about clinical characteristics of AdCa followed by SCPC who visited ED, and if these ED visits can be categorized as avoidable or unavoidable. Methods: Retrospective study of 200 consecutive AdCa evaluated by the SCPC physician who visited ED between January 2010 and December 2011. All patients were instructed to call to our main number if any change in symptoms. Based on pre-defined criteria AdCa were classified as having an avoidable (if the problem could have been managed at the outpatient center or by telephone) or unavoidable visit. Demographics and clinical characteristics were collected and analyzed. Results: 47/200 (23.5%) AdCa had avoidable ED-visits (AvED) and 153/200 (76.5%) had unavoidable ED-visits (NAvED). Main reasons for NAvED: changes in mental statu s(24/153, 16%), infectious processes (32/153, 21%), new onset/worsening of pain and dyspnea (75/153,49%), and severe worsening others symptoms (22/153,14%). Age, gender, marital status, and cancer types, reasons for referral to SCPC, and time to ED-visit after SCPC visit were not significantly different between AvED and NAvED patients. Baseline Edmonton Symptom Assessment Scale showed no significant difference in pain, dyspnea, fatigue, drowsiness, nausea, well-being, anxiety, and depression for AvED vs. NAvED; except for sleep ≥1: 141/153 (92%) vs. 37/47 (79%), p=0.01001, respectively. None of the patients phoned the SCPC before to ED visit. 17/153 (11%) of AdCa called their primary oncology before NAvED visit vs. 1/46(2%) call before AvED, p=0.078. Multivariate analysis showed that NAvED was associated with worsening of pain (OR:2.485, p<0.0179), changes in mental status (OR:23.143, p<0.0098), and sleep disturbance(OR:3.611, p<0.0116). 0/47(0%) AvED vs. 93/153 (51%) of NAvED were admitted to the hospital, p<0.0001. Conclusions: More than one in five of ED visits by AdCa are avoidable. Efforts through to improve communication after the scheduled appointments, through clinician initiated phone calls, electronic communication and more frequent visits are needed.

Use of the Edmonton Symptom Assessment Scale in patients with advanced cancer referred to an embedded palliative care clinician.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 96-96
Author(s):  
Sarah D'Ambruoso ◽  
Anne M. Walling ◽  
Sara A. Hurvitz ◽  
Alexandra Drakaki ◽  
Jonathan Wade Goldman ◽  
...  
Keyword(s):  
Symptom Assessment ◽  
Well Being ◽  
Anxiety And Depression ◽  
Initial Visit ◽  
Emotional Symptoms ◽  
Distress Screening ◽  
Palliative Oncology ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale

96 Background: Physical and emotional symptoms are highly prevalent in patients with advanced cancers and contribute to overall distress level and decreased self-reported quality of life. Oncology organizations and accrediting bodies now routinely recommend universal distress screening among patients with advanced cancers. Palliative and supportive care clinicians play an important role in implementing symptom and distress screening in cancer centers. Methods: As part of an embedded palliative care nurse practitioner (PC-NP) intervention within a large ambulatory oncology clinic, patients with advanced breast, GU, GI and lung cancer were screened for physical and emotional symptoms using the Edmonton Symptom Assessment Scale (ESAS) and treated appropriately including referral to psychology-based supportive care clinic for moderate to severe anxiety and depression or clinician-identified need. We used pre-test post-test methods to see if symptoms improved after enrollment in an embedded palliative oncology program. Results: Sixty-eight patients were screened at initial visit and 41 had follow-up screening during the first 13 months of the program with a part-time PC-NP. Only the 41 patients who had both an initial and a follow-up visit were included in the analysis. Patients were assessed using the ESAS at initial visit and at a follow-up visit an average of 5.9 weeks later (RANGE 1.0-30.6), and significant reductions were found in self-reported pain (4.0 v. 3.0), shortness of breath (3.0 v. 2.1), lack of appetite (2.8 v. 2.1), and overall well-being (4.7 v 3.8) (p < 0.05). Emotional symptoms (anxiety and depression) also decreased but were not statistically significant. Aggregate scores (emotional symptoms plus physical symptoms plus well-being) demonstrated a 6 point reduction in severity (26.2 baseline to 20.3 at follow-up, p = 0.17). Conclusions: These findings are suggestive of improvement in cancer-related symptoms and distress after enrollment in an embedded palliative oncology program. More rigorous study designs are needed to better understand the impact of the intervention on symptom management.

Tactile massage reduces rescue doses for pain and anxiety: an observational study

2017 ◽  
Vol 8 (1) ◽  
pp. 30-33 ◽  
Author(s):  
Karina Pedersen ◽  
Linda Björkhem-Bergman
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
Symptom Assessment ◽  
Well Being ◽  
Control Groups ◽  
Edmonton Symptom Assessment Scale ◽  
Before And After ◽  
Parallel Control ◽  
Symptom Assessment Scale ◽  
Harmful Effects

ObjectivesThe aim of this study was to evaluate the effect of tactile massage (TM) on palliative care patients.MethodAn observational study at a hospice ward in Sweden was carried out. Forty-one palliative patients were offered TM, at an average of three treatments per patient. Before and after every treatment, self-assessed pain, well-being and anxiety according to the Edmonton Symptom Assessment Scale (0–10) were recorded. In addition, the number of rescue doses for pain and anxiety was monitored 24 hours before and after the treatment and in two consecutive days before the patients were offered TM (control data).ResultsTM resulted in improvement of self-assessed pain by 1.7 points (SD 1.6), anxiety by 2.3 points (SD 2.0) and well-being by 2.6 points (SD 1.4). The number of rescue doses for pain was reduced from 1.6 to 0.84 doses/patient (P<0.001) and for anxiety from 0.52 to 0.24 doses/patient (P<0.01). The number of rescue doses was not changed in the same patients in two consecutive days before the patients were offered TM. The effect was evident already after the first treatment and did not increase further with repeated treatments. No patients reported any harmful effects of the treatment.ConclusionTM reduced the need for administration of rescue doses for pain and anxiety and improved well-being in palliative care patients. Larger randomised studies with parallel control groups are needed to confirm the findings from this observational pilot study.

scholarly journals Edmonton Symptom Assessment Scale and Clinical Characteristics Associated With Cannabinoid Use in Oncology Supportive Care Outpatients

2019 ◽  
Vol 17 (9) ◽  
pp. 1059-1064 ◽  
Author(s):  
Young D. Chang ◽  
Jae-Woo Jung ◽  
Ritika Oberoi-Jassal ◽  
Jongphil Kim ◽  
Sahana Rajasekhara ◽  
...  
Keyword(s):  
Supportive Care ◽  
Clinical Characteristics ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment Scale ◽  
Lower Quartile ◽  
Severity Scores ◽  
Edmonton Symptom Assessment Scale ◽  
Spiritual Well Being ◽  
Symptom Assessment Scale

Background: Information about the frequency of cannabinoid use and the clinical characteristics of its users in oncology supportive care is limited. This study explored associations between cannabinoid use and cancer-related clinical characteristics in a cancer population. Patients and Methods: This retrospective review included 332 patients who had a urine drug test (UDT) for tetrahydrocannabinol (THC) together with completion of an Edmonton Symptom Assessment Scale (ESAS) and cannabinoid history questionnaire on the same day that urine was obtained during 1 year in the supportive care clinic. Results: The frequency of positive results for THC in a UDT was 22.9% (n=76). Significant statistical differences were seen between THC-positive and THC-negative patients for age (median of 52 [lower quartile, 44; upper quartile, 56] vs 58 [48; 67] years; P<.001), male sex (53.9% vs 39.5%; P=.034), and past or current cannabinoid use (65.8% vs 26.2%; P<.001). Statistical significance was observed in ESAS items between the THC-positive and THC-negative groups for pain (7 [lower quartile, 5; upper quartile; 8] vs 5 [3; 7]; P=.001), nausea (1 [0; 3] vs 0 [0; 3]; P=.049), appetite (4 [2; 7] vs 3 [0; 5.75]; P=.015), overall well-being (5.5 [4; 7] vs 5 [3; 6]; P=.002), spiritual well-being (5 [2; 6] vs 3 [1; 3]; P=.015), insomnia (7 [5; 9] vs 4 [2; 7]; P<.001), and total ESAS (52 [34; 66] vs 44 [29; 54]; P=.001). Among patients who reported current or past cannabinoid use, THC-positive patients had higher total scores and scores for pain, appetite, overall well-being, spiritual well-being, and insomnia than THC-negative patients. Conclusions: Patients with cancer receiving outpatient supportive care who had positive UDT results for THC had higher symptom severity scores for pain, nausea, appetite, overall and spiritual well-being, and insomnia compared with their THC-negative counterparts. These results highlight potential opportunities to improve palliative care.

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