Medical Cannabis and Utilization of Nonhospice Palliative Care Services: Complements and Alternatives at End of Life

Abstract Background and Objectives There is a need to know more about cannabis use among terminally diagnosed older adults, specifically whether it operates as a complement or alternative to palliative care. The objective is to explore differences among the terminal illness population within the Illinois Medical Cannabis Program (IMCP) by their use of palliative care. Research Design and Methods The study uses primary, cross-sectional survey data from 708 terminally diagnosed patients, residing in Illinois, and enrolled in the IMCP. We compared the sample on palliative care utilization through logistic regression models, examined associations between palliative care and self-reported outcome improvements using ordinary least squares regressions, and explored differences in average pain levels using independent t-tests. Results 115 of 708 terminally diagnosed IMCP participants were receiving palliative care. We find increased odds of palliative care utilization for cancer (odds ratio [OR] [SE] = 2.15 [0.53], p < .01), low psychological well-being (OR [SE] = 1.97 [0.58], p < .05), medical complexity (OR [SE] = 2.05 [0.70], p < .05), and prior military service (OR [SE] = 2.01 [0.68], p < .05). Palliative care utilization is positively associated with improvement ratings for pain (7.52 [3.41], p < .05) and ability to manage health outcomes (8.29 [3.61], p < .01). Concurrent use of cannabis and opioids is associated with higher pain levels at initiation of cannabis dosing (p < .05). Discussion and Implications Our results suggest that cannabis is largely an alternative to palliative care for terminal patients. For those in palliative care, it is a therapeutic complement used at higher levels of pain.

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Cannabis and End-of-Life Care: A Snapshot of Hospice Planning and Experiences Among Illinois Medical Cannabis Patients With A Terminal Diagnosis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211018655 ◽

2021 ◽

pp. 104990912110186

Author(s):

James Alton Croker ◽

Julie Bobitt ◽

Sara Sanders ◽

Kanika Arora ◽

Keith Mueller ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Fast Track ◽

Hospice Care ◽

Cannabis Use ◽

Care Plan ◽

Medical Cannabis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Eol Care

Introduction: Between 2013 and 2019, Illinois limited cannabis access to certified patients enrolled in the Illinois Medical Cannabis Program (IMCP). In 2016, the state instituted a fast-track pathway for terminal patients. The benefits of medicinal cannabis (MC) have clear implications for patients near end-of-life (EOL). However, little is known about how terminal patients engage medical cannabis relative to supportive care. Methods: Anonymous cross-sectional survey data were collected from 342 terminal patients who were already enrolled in ( n = 19) or planning to enroll ( n = 323) in hospice for EOL care. Logistic regression models compare patients in the sample on hospice planning vs. hospice enrollment, use of palliative care vs. hospice care, and use standard care vs non-hospice palliative care. Results: In our sample, cancer patients ( OR = 0.21 (0.11), p < .01), and those who used the fast-track application into the IMCP ( OR = 0.11 (0.06), p < .001) were less likely to be enrolled in hospice. Compared to patients in palliative care, hospice patients were less likely to report cancer as their qualifying condition ( OR = 0.16 (0.11), p < .01), or entered the IMCP via the fast-track ( OR = 0.23 (0.15), p < .05). Discussion: Given low hospice enrollment in a fairly large EOL sample, cannabis use may operate as an alternative to supportive forms of care like hospice and palliation. Clinicians should initiate conversations about cannabis use with their patients while also engaging EOL Care planning discussions as an essential part of the general care plan.

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Mapping the FACT-G to EQ-5D Utility Index in Cancer: Data From a Cross-sectional Study in China

10.21203/rs.3.rs-110170/v1 ◽

2020 ◽

Author(s):

ZhiKui He ◽

Li Yang ◽

WenJie Liang ◽

WenJia Xu ◽

WenXiu Huang ◽

...

Keyword(s):

Regression Models ◽

Mean Squared Error ◽

Explanatory Power ◽

Well Being ◽

Ordinary Least Squares ◽

Cost Utility ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Cancer Data ◽

Utility Index

Abstract ObjectiveThis study aimed to develop a function for mapping the cancer-specific instrument (FACT–G) to a preference-based measure (EQ-5D-3L) utility index for HRQoL, in which the utility scores were generated using the Chinese value set.MethodThe data are based on a cross-sectional survey of 243 patients in China with different cancer types. Cancer patients who completed the EQ-5D-3 L and the FACT-G questionnaire, and patient demographics and clinical characteristics were included in this study. Regression models were used to predict the EQ-5D-3L utility index values based on four subscale scores of the FACT-G using the ordinary least squares (OLS) model, generalized linear models (GLM), censored least absolute deviations (CLAD), Tobit model, and two-part model (TPM) regression approaches. The performance and predictive power of each model were also evaluated using r2 and adj- r2, mean absolute error (MAE) and root mean squared error (RMSE).ResultsThe introduction of the square term and the interaction term improves the accuracy of the model. The social well-being subscale of the FACT-G was not associated with the EQ-5D-3L utility index, whereas, the physical, emotional, functional well-being, and FACT-G total scores were derived when mapping the FACT-G to the EQ-5D-3L utility index. For the FACT-G, the OLS model was the best at predicting mean EQ-5D-3L values among all the regression models and has 70% explanatory power for the observed EQ-5D-3L variation. Nevertheless, the OLS model overpredicted utilities for poorer health states and underestimated utilities for those with better health. The result of the OLS model, GLM, and CLAD models were similar to the MAE, MSE, and RMSE.ConclusionThe algorithm based on Chinese population development for mapping the FACT-G into the EQ-5D-3L utility index can be realized. We also recommend that OLS models be used to assess the economic evaluation of patients' health-related quality of life when the population is in moderate to good health for further cost-utility analysis in China.

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Impostor Phenomenon in the Nutrition and Dietetics Profession: An Online Cross-Sectional Survey

10.1101/2021.12.05.21267322 ◽

2021 ◽

Author(s):

Matthew J. Landry ◽

Dylan A. Bailey ◽

MinJi Lee ◽

Samuel Van Gundy ◽

Audrey Ervin

Keyword(s):

Job Satisfaction ◽

Online Survey ◽

Well Being ◽

Impostor Phenomenon ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Logistic Regression Models ◽

Registered Dietitian Nutritionists ◽

Prevention Methods ◽

Nutrition And Dietetics

AbstractBackgroundImpostor phenomenon (IP) (also known as impostor syndrome) describes high-achieving individuals who, despite their objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or impostor. Despite robust literature describing the effects of IP in other health care professions, there is an absence of research within the nutrition and dietetics profession.ObjectiveTo assess the prevalence and predictors of IP within the nutrition and dietetics students and practitioners.DesignAn online cross-sectional survey was conducted.Participants/setting1,015 students, dietetic interns, and currently practicing and retired nutrition and dietetic technicians registered, and registered dietitian nutritionists provided complete responses.Main outcome measuresImpostor phenomenon was assessed with the Clance Impostor Phenomenon Scale (CIPS). Self-reported Job satisfaction and well-being were assessed using validated scales.Statistical analysesDescriptive statistics were summarized and reported using frequency counts and percentages. Unadjusted logistic regression models were used to assess the relationship between IP and sociodemographic outcomes, job satisfaction, and well-being.ResultsRespondents were primarily female, non-Hispanic White, and practicing dietitians. The average CIPS score was 66.0 ± 16.3 (range 22-99). 64% of survey respondents (n=655) experience intense or frequent IP and 62% (n=628) had a CIPS score ≥62. Older age, educational attainment, professional level, and membership in Academy groups were associated with lower IP scores. Greater Social media use was associated with higher IP scores. Job satisfaction and overall well-being were inversely correlated with impostor phenomenon (p<0.001).ConclusionsFindings from an online survey suggest that a majority of nutrition and dietetics students and practitioners experience IP. Our results reinforce the need to recognize and address this issue by raising awareness, using early prevention methods, and supporting individuals who are younger and/or new to the profession.

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Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: a cross-sectional survey in Karachi, Pakistan

BMC Palliative Care ◽

10.1186/s12904-020-00688-w ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Sameena Shah ◽

Faizan Qaisar ◽

Iqbal Azam ◽

Khairunnisa Mansoor

Keyword(s):

Palliative Care ◽

Terminal Illness ◽

Multivariable Analysis ◽

Age Groups ◽

Care Program ◽

Education Level ◽

Social Needs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Care Approach

Abstract Background Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach. Method A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence’s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant. Results Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes. Conclusion Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers.

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Characteristics of Hospice and Palliative Care Programs in US Prisons: An Update and 5-Year Reflection

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119893090 ◽

2019 ◽

Vol 37 (7) ◽

pp. 514-520

Author(s):

Stephanie Grace Prost ◽

Margaret M. Holland ◽

Heath C. Hoffmann ◽

George E. Dickinson

Keyword(s):

Palliative Care ◽

Terminal Illness ◽

Management Strategies ◽

Public Support ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Frequency Distributions ◽

Dying Patients ◽

Palliative Care Services ◽

Hospice And Palliative Care

Individuals with terminal illness are dying behind bars and many state prison administrators have incorporated on-site hospice and palliative care services. Little is known, however, about these programs since a 2010 study of prison hospice characteristics. We provide an updated description and reflection of current hospice and palliative care programs in state prisons serving incarcerated persons with terminal illness. A cross-sectional survey was sent to representatives of all known prisons offering hospice and palliative care programs and services (N = 113). Questions were drawn from an earlier iteration regarding interdisciplinary team (IDT) membership, training length and topics, peer caregivers, visitation policies, bereavement services, perceived stakeholder support, and pain management strategies. Additional questions were added such as estimated operational costs, peer caregiver input in patient care, and the strengths and weaknesses of such programs. Frequency distributions were calculated for all study variables. Responding representatives (n = 33) indicated IDTs remain integral to care, peer caregivers continue to support dying patients, and perceived public support for these programs remains low. Reduced enthusiasm for the programs may negatively influence administrative decision-making and program resources. Further, peer caregiver roles appear to be changing with caregivers charged with fewer of the identified tasks, compared with the 2010 study.

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Cannabis at the End of Life: A Road More Traveled

Innovation in Aging ◽

10.1093/geroni/igab046.1963 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 511-511

Author(s):

J Alton Croker

Keyword(s):

Health Status ◽

Cancer Diagnosis ◽

Military Service ◽

Psychological Wellbeing ◽

Medical Cannabis ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Concurrent Use ◽

Medical Complexity ◽

Overall Health Status

Abstract This study examines medical cannabis as a complement or alternative to palliative care (PC). Using cross-sectional survey data from 708 terminal patients in the Illinois Medical Cannabis Program, we compare those in PC (n = 115) to those who are not (n = 593). Increased odds of PC utilization were observed for prior military service, cancer diagnosis, low psychological wellbeing, and medical complexity. PC was positively associated with improvement scores for pain, and ability to manage health status. Higher pain levels were also observed for PC patients who indicated concurrent use of cannabis and opioids, compared to those not using opioids. While most terminal patients use cannabis as an alternative to PC, medical cannabis does operate as a therapeutic complement for individuals in PC to help manage pain and overall health status, and is used at higher levels of pain when patients are also using opioids.

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PERCEIVED EFFECTS OF STREET HAWKING ON THE WELL-BEING OF CHILDREN IN ANYIGBA, DEKINA LOCAL GOVERNMENT AREA OF KOGI STATE, NIGERIA

Pakistan Journal of Public Health ◽

10.32413/pjph.v8i1.138 ◽

2018 ◽

Vol 8 (1) ◽

pp. 01-07

Author(s):

Alfred Eboh

Keyword(s):

Local Government ◽

Survey Design ◽

Sampling Technique ◽

Well Being ◽

Local Government Area ◽

Negative Consequences ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Perceived Effects ◽

The Government

Background: The hawking of wares by children has been a serious issue confronting the Nigerian society. Children hawk in some of the most horrible conditions conceivable, where they face a serious risk of injury, chronic illness, kidnapping, rape or death. Objective: The focus of this study was to assess the perceived effects of street hawking on the well-being of children in Anyigba, Dekina Local Government Area of Kogi State. Methods: The population of this study consists of parents of the street hawkers in Anyigba while cross-sectional survey design was used through the purposive sampling technique to choose the sample size of one hundred and sixty-two (162) respondents. The validated structured questionnaire and In-Depth Interviews (IDIs) served as the instruments for the data collection respectively. The hypotheses were tested using Chi-Square at a predetermined 0.05 level of significance. The quantitative data were analysed with the aid of the SPSS (version 20). Results: The results indicated among others that street hawking had significant social implications and physical consequences on children's moral behaviour as well as health status in the study area. Conclusion: The study, therefore, concluded that the government of Kogi State should carry out an enlightenment campaign through the media and religious institutions on the negative consequences of street hawking are recommended as panacea. Also, the child right act instrument and its implementation should be strengthened in order to curb street hawking in the study area.

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The COVID‐19 pandemic and healthcare workers psychological well‐being: a cross‐sectional survey in Indonesia

Nursing Open ◽

10.1002/nop2.1034 ◽

2021 ◽

Author(s):

Ni’matuzahroh ◽

Valendriyani Ningrum ◽

Widayat ◽

Myrtati Dyah Artaria ◽

Mein‐Woei Suen

Keyword(s):

Healthcare Workers ◽

Well Being ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Psychological Well Being

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Prepared and highly committed despite the risk of COVID-19 infection: a cross-sectional survey of primary care physicians’ concerns and coping strategies in Singapore

BMC Family Practice ◽

10.1186/s12875-021-01370-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jerrald Lau ◽

David Hsien-Yung Tan ◽

Gretel Jianlin Wong ◽

Yii-Jen Lew ◽

Ying-Xian Chua ◽

...

Keyword(s):

Primary Care ◽

Coping Strategies ◽

Stress Management ◽

Primary Care Physicians ◽

Well Being ◽

Pandemic Preparedness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Accessible Information ◽

And Coping

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.

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