From scientific evidence to clinical practice in cancer patients: NANDA-I: imbalanced nutrition: less than body requirements (00002) and care planning

BACKGROUND The Patient Reported Outcomes Version of the Common Terminology Criteria of Adverse Events (PRO-CTCAE) item library covers a wide range of symptoms relevant for oncology care. To enable implementation of PRO-CTCAE-based symptom monitoring in clinical practice, there is a need to select a subset of items relevant for specific patient populations. OBJECTIVE The aim of this study was to develop a PRO-CTCAE subset relevant for patients with lung cancer. METHODS The PRO-CTCAE-based subset for lung cancer patients was generated using a mixed methods approach based on the European Organization for Research and Treatment of Cancer (EORTC) guidelines for developing questionnaires, consisting of a literature review and semi-structured interviews with both lung cancer patients and health care practitioners (HCPs). Both patients and HCPs were queried on the relevance and impact of all PRO-CTCAE items. Results were summarized and, after a final round of expert review, a selection of clinically relevant items for lung cancer patients was made. RESULTS A heterogeneous group of lung cancer patients (n=25) from different treatment modalities and HCPs (n=22) participated in the study. A final list of eight relevant PRO-CTCAE items was created: decreased appetite, cough, shortness of breath, fatigue, constipation, nausea, sadness, and pain (general). CONCLUSIONS Based on literature and both professional and patient input, a subset of PRO-CTCAE items has been identified for use in lung cancer patients in clinical practice. Future work is needed to confirm the validity and effectiveness of this PRO-CTCAE lung cancer subset internationally, and in the real-world clinical practice setting.

Download Full-text

An introduction to advance care planning: practice at the frontline

10.1093/oso/9780198802136.003.0003 ◽

2018 ◽

Author(s):

Anjali Mullick ◽

Jonathan Martin

Keyword(s):

Decision Making ◽

Clinical Practice ◽

Communication Skills ◽

Advance Care Planning ◽

Use Case ◽

Care Planning ◽

Practical Advice ◽

Future Care ◽

Case Vignettes ◽

Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

Download Full-text

The lack of scientific evidence in clinical practice guideline in brain death determination: Implications for organ donation and transplantation

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.140136 ◽

2014 ◽

Vol 18 (9) ◽

pp. 555-557 ◽

Cited By ~ 2

Author(s):

Joseph L. Verheijde ◽

Mohamed Y. Rady

Keyword(s):

Clinical Practice ◽

Brain Death ◽

Organ Donation ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Scientific Evidence ◽

Brain Death Determination ◽

Death Determination

Download Full-text

Video decision support tool promoting values conversations in advanced care planning in cancer: protocol of a randomised controlled trial

BMC Palliative Care ◽

10.1186/s12904-021-00794-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Natasha Michael ◽

Clare O’Callaghan ◽

Ekavi Georgousopoulou ◽

Adelaide Melia ◽

Merlina Sulistio ◽

...

Keyword(s):

Decision Making ◽

Decision Support ◽

Cancer Patients ◽

Personal Values ◽

Decision Support Tool ◽

Trial Registration ◽

Randomised Control Trial ◽

Care Planning ◽

Advanced Directives ◽

Support Tool

Abstract Background Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s. Methods This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. Conclusion We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered.

Download Full-text

The Role of Advance Care Planning in Cancer Patient and Caregiver Grief Resolution: Helpful or Harmful?

Cancers ◽

10.3390/cancers13081977 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1977

Author(s):

Francesca Falzarano ◽

Holly G. Prigerson ◽

Paul K. Maciejewski

Keyword(s):

Cancer Patients ◽

Family Caregivers ◽

Advance Care Planning ◽

Care Planning ◽

Do Not Resuscitate ◽

Prospective Longitudinal Study ◽

Advance Care ◽

Grief Resolution ◽

Caregiver Grief ◽

Prospective Longitudinal

Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief resolution among cancer patients and caregivers. To fill this knowledge gap, the current study examined changes in grief over time in patients and their family caregivers and whether changes in patient grief are associated with changes in caregiver grief. We also sought to determine how grief changed following the completion of advance directives. The sample included advanced cancer patients and caregivers (n = 98 dyads) from Coping with Cancer III, a federally funded, multi-site prospective longitudinal study of end-stage cancer care. Participants were interviewed at baseline and at follow-up roughly 2 months later. Results suggest synchrony, whereby changes in patient grief were associated with changes in caregiver grief. We also found that patients who completed a living will (LW) experienced increases in grief, while caregivers of patients who completed a do-not-resuscitate (DNR) order experienced reductions in grief, suggesting that ACP may prompt “grief work” in patients while promoting grief resolution in caregivers.

Download Full-text

Efficacy and Safety of Lipegfilgrastim in Lung Cancer Patients Receiving Myelosuppressive Chemotherapy in a Real-World Setting: Results of an Analysis of Pooled Data from Two Non-Interventional European Studies

Oncology Research and Treatment ◽

10.1159/000512594 ◽

2021 ◽

pp. 1-9

Author(s):

Christian Gessner ◽

Karin Potthoff ◽

Nikolaj Frost

Keyword(s):

Lung Cancer ◽

Clinical Practice ◽

Cancer Patients ◽

Adverse Drug Reactions ◽

Real World ◽

Secondary Prophylaxis ◽

Drug Reactions ◽

Myelosuppressive Chemotherapy ◽

Lung Cancer Patients ◽

Chemotherapy Induced Neutropenia

Background/Aim: Chemotherapy-induced neutropenia is a common and serious complication in cancer patients receiving myelosuppressive chemotherapy. This analysis was undertaken to evaluate the effectiveness and safety of prophylaxis with lipegfilgrastim, a glycoPEGylated granulocyte colony-stimulating factor, in lung cancer patients undergoing chemotherapy in real-world clinical practice. Methods: Data from two European non-interventional studies (NIS NADIR and NIS LEOS) investigating lipegfilgrastim for primary and secondary prophylaxis were pooled. Outcomes included the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN), use of anti-infectives and antimycotics, and adverse events and their relationship to lipegfilgrastim. Results: The safety population included 361 patients with lung cancer (median age, 66 years [range, 36–88]), of whom 322 had received 2 or more consecutive cycles of lipegfilgrastim (efficacy population [primary prophylaxis, 75.5%; secondary prophylaxis, 16.5%]). Almost 40% of the patients were considered to have a high risk (>20%) of FN, and around 60% had an intermediate risk (10–20%). For all cycles, FN was reported in 3 patients (0.9%), neutropenia in 14 (4.3%), and grade 4 neutropenia in 9 (2.8%). Anti-infectives were used in 27 patients (8.4%) and antimycotics in 6 (1.9%). The incidence rates were lower for the patients’ first cycle (FN, 0.4%; neutropenia, 0.8%; grade 4 neutropenia, 0.8%; anti-infectives, 0.6%; antimycotics, 0.6%). Adverse drug reactions considered lipegfilgrastim related were reported in 35 patients (9.7%), and serious adverse drug reactions in 10 (2.8%). None of the fatal events reported in 28 patients (7.8%) were lipegfilgrastim related. Conclusion: Lipegfilgrastim administered to patients with lung cancer undergoing chemotherapy in real-world clinical practice showed similar effectiveness and safety to that reported in published pivotal trials.

Download Full-text