Skin problems in palliative care

2019 ◽  
pp. 407-420
Keyword(s):  
Palliative Care ◽  
Wound Care ◽  
Metastatic Cancer ◽  
Physical Symptoms ◽  
Skin Involvement ◽  
Skin Disorders ◽  
Advanced Malignancy ◽  
Drug Treatments ◽  
Palliative Care Units

This chapter discusses skin disorders. Skin disorders affect patients with early and advanced malignant and non-malignant disease. In addition to distressing physical symptoms, the appearance of pressure sores, malignant wounds, and lymphoedema impact on patients’ social functioning, mood, and quality of life. Meticulous and prompt management of symptoms can make a huge difference. There is a growing body of research into drug treatments for pruritus in palliative care, and interventions for managing lymphoedema and wounds more effectively. Key principles in the management of wound care, lymphoedema, and pruritus are examined. Skin wounds are common in advanced malignancy. Pressure ulcers are most frequently seen, affecting an estimated one-third or more of patients in palliative care units. Malignant/fungating wounds occur in approximately 5–10% patients with metastatic cancer and are associated with significant physical and psychological distress. Loco-regional skin involvement (e.g. breast fungation) should be distinguished from generalized skin metastases which imply advanced disease.

Quality of life change and response shift in patients admitted to palliative care units: a pilot study

2005 ◽  
Vol 19 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Michael A Echteld ◽  
Luc Deliens ◽  
Marcel E Ooms ◽  
Miel W Ribbe ◽  
Gerrit van der Wal
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Pilot Study ◽  
Response Shift ◽  
Life Change ◽  
Palliative Care Units

scholarly journals Quality of Care and Satisfaction With Care on Palliative Care Units

2016 ◽  
Vol 51 (2) ◽  
pp. 184-192 ◽  
Author(s):  
Kirsten Wentlandt ◽  
Dori Seccareccia ◽  
Nanor Kevork ◽  
Kevin Workentin ◽  
Susan Blacker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
Satisfaction With Care ◽  
Palliative Care Units

scholarly journals A Second Time Nationwide Survey of Quality of End-of-Life Cancer Care in General Hospitals, Inpatient Palliative Care Units, and Clinics in Japan: The J-HOPE 2 Study

2016 ◽  
Vol 11 (4) ◽  
pp. 254-264 ◽  
Author(s):  
Megumi Shimizu ◽  
Maho Aoyama ◽  
Tatsuya Morita ◽  
Satoru Tsuneto ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Care ◽  
Nationwide Survey ◽  
General Hospitals ◽  
Palliative Care Units

scholarly journals Severe symptoms and very low quality-of-life among outpatients newly diagnosed with advanced cancer: data from a multicenter cohort study

2020 ◽  
Vol 28 (11) ◽  
pp. 5547-5555
Author(s):  
Waldemar Siemens ◽  
Stefan S. Schönsteiner ◽  
Claudia Lorena Orellana-Rios ◽  
Ulrike Schaekel ◽  
Jens Kessler ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Physical Symptoms ◽  
Newly Diagnosed ◽  
Multicenter Cohort Study ◽  
European Organization ◽  
Multicenter Cohort

Abstract Purpose The aim of this study was to identify symptoms of severe intensity or very low scores for quality of life (QoL) domains in newly diagnosed outpatients with advanced cancer. Methods This multicenter cohort study from a state-wide palliative care network included adult outpatients with advanced cancer diagnosed within the preceding 8 weeks from four comprehensive cancer centers (DRKS00006162, registered on 19 May 2014). We used the Palliative Outcome Scale (POS), Hospital Anxiety and Depression Scale, and European Organization for Research and Treatment of Cancer QoL Questionnaire-C30. For each questionnaire, cut-off scores defined symptoms and QoL domains that were considered “severe” or “very low.” Results Of 3155 patients screened, 481/592 (81.3%) were analyzed (mean age 62.4; women n = 245, 50.9%). We identified 324/481 (67.4%) patients experiencing at least one severe symptom or a very low QoL domain (median 2; range 0 to 16). Role functioning (n = 180, 37.4%), fatigue (n = 162, 33.7%), and social functioning (n = 126, 26.2%) were most commonly affected. QoL was very low in 89 patients (18.5%). Women experienced more anxiety symptoms, fatigue, and had lower POS scores. Patients often mentioned physical symptoms and fears of adverse events resulting from disease-modifying therapies (e.g., chemotherapy) as most relevant problems. Conclusions Already within the first 8 weeks after diagnosis, the majority of patients reported at least one severe symptom or a very low QoL domain. Gender differences were evident. The findings illustrate the value of early routine assessment of patient burden and the development of multi-professional and interdisciplinary palliative care.

Utilization of palliative care in patients with genitourinary malignancies.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 669-669
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Rashmi Verma
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Terminal Illness ◽  
Hospital Admissions ◽  
Metastatic Cancer ◽  
Private Insurance ◽  
Malignant Neoplasm ◽  
The West ◽  
Factors Affecting

669 Background: Palliative care provides support and improves the quality of life of patients who has terminal illness such as cancer. Studies have shown that integrating palliative care into cancer care soon after the diagnosis of metastatic cancer can improve the quality of life and also prolong survival. The objective of the study was to analyze the acceptance of palliative care and to determine the factors affecting the utilization of palliative care in patients with genitourinary (GU) cancers. Methods: The National Inpatient Sample Database for the year 2016 was queried for the data. Patients who were admitted with a principal diagnosis of Malignant Neoplasm of Prostate (MNP), Renal Cell Carcinoma (RCC), Malignant Neoplasm of Ureter (MNU) were identified using ICD-10 codes and those who had Encounter for Palliative Care (PC) was also identified. Results: A total of 58765 hospitalizations were identified with MNP (n=39853), RCC (n=17786), MNU (n= 1126) during the study period. The total PC utilization for the above patients were 6.4% (n= 3785). Among those, 6.7% (n=1186), 6.3% (n=2531), 6.03% (n=68) from the groups RCC, MNP, MNU respectively received PC. The mean age for the PC utilization was 73 years (MNP= 72 yrs, RCA= 63 yrs, UCC= 73 yrs). Females received more PC when compared to males (6.7% vs 6.4%). Among those who had PC 27.4% (n=1029) died in the hospital. Interestingly, patients who had Medicare and Medicaid had more PC encounters when compared to those with private insurance (OR= 1.21, P= 0.001). Patients admitted on the weekend received more PC when compared to those who admitted during weekdays (OR= 1.12, P= 0.001). Patients admitted to hospitals in the West received more PC than other regions (OR= 1.42, P=0.03). Impact of race, teaching vs non-teaching hospital admissions were not found to be statistically significant in the utilization of PC in the above GU cancers. Conclusions: Medicare and Medicaid patients, weekend admissions, admissions to hospitals in the West received more palliative care. Further studies are needed to reveal the role of socioeconomic status and insurance in the utilization of palliative care in GU malignancies.

End-stage pulmonary disease

2007 ◽  
pp. 99-102
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Physical Symptoms ◽  
Curative Treatment ◽  
Total Care ◽  
End Stage ◽  
Spiritual Problems

End-stage pulmonary disease 100 The WHO defines palliative care as the active total care of patients whose disease is not responsive to curative treatment. The goal of palliative care is achievement of best quality of life for patients and their families. It includes control of pain and other physical symptoms as well as care of psychological, social and spiritual problems....

Palliative Care in the Last Hours of Life

2018 ◽  
Author(s):  
Ahsan Azhar
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Communication Skills ◽  
Physical Symptoms ◽  
Accurate Assessment ◽  
Effective Management ◽  
Relief Of Suffering ◽  
Key Aspects

Patients with life-limiting illnesses often experience severe distressing psychosocial and physical symptoms during the last hours of life. Prompt relief of suffering is paramount; hence, accurate assessment and effective management of symptoms, along with excellent communication skills, help clinicians not only relieve patients’ distressing symptoms but also provide education about end of life along with psychosocial and emotional support to the caregivers. The aim is for improving the quality of life of patients and caregivers and reduce the incidence of complicated grief especially among the over-whelmed caregivers. This chapter reviews the key aspects of care of patients in the last hours of life.

Assessing quality of end-of-life hospital care in a southern European regional health service

2005 ◽  
Vol 21 (4) ◽  
pp. 464-470 ◽  
Author(s):  
Elena Aldasoro ◽  
Adelina Pérez Alonso ◽  
Laureano Ribacoba ◽  
Santiago Esnaola ◽  
Maite Olaizola ◽  
...  
Keyword(s):  
Palliative Care ◽  
Quality Of Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Care ◽  
Symptom Control ◽  
Hospital Services ◽  
Palliative Care Units ◽  
Clinical Records

Objectives:During the final period of life, patients with cancer in the Basque Country are given treatment in different types of hospital care. This study compared the quality of care according to the type of care in one of the autonomous communities in Spain.Methods:A retrospective study was carried out of cancer patients who died in conventional hospital services, home hospitalization services, and palliative care units. In addition to hospital stay and readmission number, variables based on the recommendations of Spanish Society for Palliative Care were studied.Results:End-of-life was diagnosed in 57 percent of a sample of 486 patients, 3 days before death (median). The use of symptom control scales was only documented in the clinical records of eight patients. Sociofamily evaluation was not found. Patients in conventional hospital services were less frequently diagnosed with end-of-life and agony and were significantly different from the rest in the reasons for admission, symptoms assessed, drugs used, administration routes, and dosage forms. Pain was evaluated in 50 percent of the patients and was better controlled in palliative care units. Patients not diagnosed with agony (52 percent) were more frequently not given specific treatment.Conclusions:End-of-life in cancer patients was diagnosed too late. The quality of care in palliative care units and by home hospitalization service was better than that in conventional hospitalization. Nevertheless, there were areas for improvement in the three modalities of care.

Pathways for a ‘Good Death’: Understanding End-of-Life Practices Through An Ethnographic Study in Two Portuguese Palliative Care Units

2020 ◽  
pp. 136078042097272
Author(s):  
Ana Patrícia Hilário ◽  
Fábio Rafael Augusto
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
Participant Observation ◽  
Family Members ◽  
Well Being ◽  
Physical Symptoms ◽  
Ethnographic Study ◽  
Good Death ◽  
Palliative Care Units

Drawing upon ethnographic research developed in two Portuguese palliative care units, this article seeks to analyse end-of-life practices, namely how they are perceived and negotiated among the various actors involved. Over a period of 10 months in these units participant observation and in-depth interviews were conducted with 20 family members of patients with a life-threatening illness and 20 health care professionals. Against this backdrop, aspects related to the concept of a ‘good death’, the management of pain and suffering, and the loss of consciousness were explored. The main findings pointed to an appreciation, both by professionals and family members, of an holistic intervention that guarantees the patient’s physical, psychological, social, and spiritual well-being, where the relief of physical symptoms is of particular importance and palliative sedation emerges as a mechanism that allows the patient to achieve a ‘good death’ (without suffering and in a peaceful way).

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