Delirium

2015 ◽  
Author(s):  
Meera Agar ◽  
Yesne Alici ◽  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Terminally Ill ◽  
Symptomatic Treatment ◽  
Significant Morbidity ◽  
Pharmacological Interventions ◽  
Advanced Illness ◽  
Delirious Patient ◽  
Risks And Benefits ◽  
Impending Death

Delirium is the most common and serious neuropsychiatric complication in palliative care settings. It is a source of significant morbidity in patients, and often distresses family members and staff. Delirium is often a harbinger of impending death and can significantly interfere with pain and symptom control. Unfortunately delirium is often under-recognized or misdiagnosed in the terminally ill, and even when recognized, it frequently goes untreated or is inappropriately treated. Clinicians who care for patients with advanced illness must be able to diagnose delirium accurately, undertake appropriate assessment of aetiologies, and understand the risks and benefits of the pharmacological and non-pharmacological interventions currently available for managing delirium. Symptomatic treatment with antipsychotics or sedative medications is often necessary for the delirious patient with advanced illness to minimize distress to patients, families, and staff.

Delirium

2021 ◽  
pp. 764-772
Author(s):  
Meera Agar ◽  
Yesne Alici ◽  
Augusto Caraceni ◽  
William Breitbart
Keyword(s):  
Palliative Care ◽  
Poor Prognosis ◽  
Symptom Control ◽  
Care Patient ◽  
Treatment Goals ◽  
Palliative Care Patient ◽  
Significant Morbidity ◽  
Pharmacological Interventions ◽  
Advanced Illness ◽  
Illness Trajectory

Delirium is the most common and serious neuropsychiatric disorder experienced by people with advanced illness. It leads to significant morbidity, and significant distress for the person themselves, family members and staff. Delirium often bodes of a poor prognosis and can significantly interfere with pain and symptom control. Unfortunately, delirium is often under-recognized or misdiagnosed in the palliative care patient, and even when recognized, it frequently goes untreated or is inappropriately treated. Clinicians who care for patients with advanced illness must be able to diagnose delirium accurately; undertake appropriate assessment of aetiologies and consider their treatment with due consideration of treatment goals and illness trajectory; and individualize the pharmacological and non-pharmacological interventions to support delirium recovery, maximize patient safety, and reduce distress from symptoms.

Death and dying

2012 ◽  
pp. 637-652
Author(s):  
Lesley K Bowker ◽  
James D Price ◽  
Sarah C Smith
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Death And Dying ◽  
Terminally Ill ◽  
Bad News ◽  
Breaking Bad News ◽  
Subcutaneous Infusion ◽  
Breaking Bad

Breaking bad news 638 HOW TO . . . Break bad news 639 Bereavement 640 HOW TO . . . Promote a ‘healthy bereavement’ 641 Palliative care 642 Symptom control in the terminally ill 644 HOW TO . . . Prescribe a subcutaneous infusion for palliative care 646 Documentation after death 648 Other issues after death ...

Methods of Hydration in Palliative Care Patients

1998 ◽  
Vol 14 (2) ◽  
pp. 6-13 ◽  
Author(s):  
Nathalie Steiner ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Oral Intake ◽  
Fluid Replacement ◽  
Hydration Status ◽  
Terminal Cancer ◽  
Risks And Benefits ◽  
Intravenous Hydration ◽  
Potential Risks ◽  
Careful Assessment

A strong and often polarized debate has taken place during recent years concerning the consequences of dehydration in the terminally ill patient. When a patient has a severely restricted oral intake or is found to be dehydrated, the decision to administer fluids should be individualized and made on the basis of a careful assessment that considers problems related to dehydration, potential risks and benefits of fluid replacement, and patients’ and families’ wishes. This review discusses the assessment of hydration status in the terminal cancer patient and the options for fluid administration in the cases where evaluation of the patients’ condition has led to this indication. These include different modes of hypodermoclysis, intravenous hydration, use of the nasogastric route, and proctoclysis. Arguments for and against rehydration have been previously addressed by other authors and fall outside the scope of this review.

scholarly journals Safety and Utility of Chloroquine/ Hydroxychloroquine in Palliative Care Patients

2020 ◽  
pp. 104990912095277
Author(s):  
Eric Prommer
Keyword(s):  
Palliative Care ◽  
Inflammatory Responses ◽  
Therapeutic Potential ◽  
Symptom Control ◽  
In Vivo Studies ◽  
Advanced Illness ◽  
Know How ◽  
Seriously Ill

The coronavirus disease 2019 (COVID-19) pandemic represents a significant healthcare challenge for the world. Many drugs have therapeutic potential. The aminoquinolones, hydroxychloroquine, and chloroquine are undergoing evaluation as a potential therapy against COVID -19. In vitro and in vivo studies suggest that these drugs affect viral adherence and modify inflammatory responses, which may provide some impact on the symptoms associated with COVID. As palliative care specialists encounter more COVID positive patients, palliative care specialists need to know how these drugs work, and importantly how they interact with palliative care drugs used for symptom control. At the same time, there is a need to reduce polypharmacy in any seriously ill patient population. The goals of this paper are to identify whether or not hydroxychloroquine/chloroquine improves symptoms in palliative care patients and whether or not these drugs are safe to use in the advanced illness population who have COVID.

Death and dying

2018 ◽  
Author(s):  
Lesley K. Bowker ◽  
James D. Price ◽  
Ku Shah ◽  
Sarah C. Smith
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Death And Dying ◽  
Terminally Ill ◽  
Bad News ◽  
Assisted Dying ◽  
Breaking Bad News ◽  
Breaking Bad

This chapter provides information on breaking bad news, bereavement, palliative care, symptom control in the terminally ill, assisted dying, documentation after death, other issues after death, and the coroner.

Hypodermoclysis (HDC) for Symptom Control Vs. the Edmonton Injector (EI)

1991 ◽  
Vol 7 (4) ◽  
pp. 5-8 ◽  
Author(s):  
Robin L. Fainsinger ◽  
Eduardo Bruera
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Terminally Ill ◽  
Palliative Care Unit ◽  
New Method ◽  
Time Saving ◽  
Treatment Methods ◽  
Terminally Ill Patients

Hypodermoclysis (HDC) is a well-known method of providing symptom control in terminally ill patients. In this article we make reference to two previous reports describing our use of HDC and a new method of subcutaneous narcotic delivery called the Edmonton Injector (El). The rationale for using HDC mainly for rehydration and the El when subcutaneous narcotics are needed is explored. The controversy surrounding the treatment of dehydration in the terminally ill is examined. Finally, the advantages on our palliative care unit of the convenience, increased flexibility, and cost and time saving of these two treatment methods are discussed.

Delirium in Palliative Care

2014 ◽  
pp. 55-69
Author(s):  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Patient Population ◽  
Symptom Control ◽  
Terminally Ill ◽  
Evidence Based ◽  
Advanced Cancer Patients ◽  
Treatment And Prevention ◽  
Psychopharmacological Agents

Delirium is the most common and serious neuropsychiatric complication in palliative care settings. Delirium is often under-recognized or misdiagnosed in terminally ill patients. Delirium is highly prevalent and is a source of morbidity in patients, family members, and staff. Delirium is often a harbinger of impending death and can significantly interfere with pain and symptom control among terminally ill. This chapter provides an overview of the prevalence, assessment, and management of delirium among advanced cancer patients reviewing the most recent evidence-based data on the use of psychopharmacological agents in treatment and prevention of delirium in this patient population.

Happiness at the end of life: A qualitative study

2021 ◽  
pp. 1-7
Author(s):  
Tan Seng Beng ◽  
Wong Ka Ghee ◽  
Ng Yun Hui ◽  
Ooi Chieh Yin ◽  
Khoo Wei Shen Kelvin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Terminally Ill ◽  
Social Connections ◽  
Targeted Interventions ◽  
Pain And Suffering ◽  
The University ◽  
Eudaimonic Happiness

Abstract Objective Dying is mostly seen as a dreadful event, never a happy experience. Yet, as palliative care physicians, we have seen so many patients who remained happy despite facing death. Hence, we conducted this qualitative study to explore happiness in palliative care patients at the University of Malaya Medical Centre. Method Twenty terminally ill patients were interviewed with semi-structured questions. The results were thematically analyzed. Results Eight themes were generated: the meaning of happiness, connections, mindset, pleasure, health, faith, wealth, and work. Our results showed that happiness is possible at the end of life. Happiness can coexist with pain and suffering. Social connections were the most important element of happiness at the end of life. Wealth and work were given the least emphasis. From the descriptions of our patients, we recognized a tendency for the degree of importance to shift from the hedonic happiness to eudaimonic happiness as patients experienced a terminal illness. Significance of results To increase the happiness of palliative care patients, it is crucial to assess the meaning of happiness for each patient and the degree of importance for each happiness domain to allow targeted interventions.

scholarly journals Symptom clusters and their influence on prognosis using EORTC QLQ-C15-PAL scores in terminally ill patients with cancer

2021 ◽  
Author(s):  
Nanako Koyama ◽  
Chikako Matsumura ◽  
Yuuna Tahara ◽  
Morito Sako ◽  
Hideo Kurosawa ◽  
...  
Keyword(s):  
Palliative Care ◽  
Terminally Ill ◽  
Symptom Clusters ◽  
Rank Test ◽  
Appetite Loss ◽  
Patients With Cancer ◽  
Terminally Ill Patients ◽  
Log Rank Test ◽  
Eortc Qlq ◽  
Cluster 2

Abstract Purpose The aims of the present study were to investigate the symptom clusters in terminally ill patients with cancer using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL), and to examine whether these symptom clusters influenced prognosis. Methods We analyzed data from 130 cancer patients hospitalized in the palliative care unit from June 2018 to December 2019 in an observational study. Principal component analysis was used to detect symptom clusters using the scored date of 14 items in the QLQ-C15-PAL, except for overall QOL, at the time of hospitalization. The influence of the existence of these symptom clusters and Palliative Performance Scale (PPS) on survival was analyzed by Cox proportional hazards regression analysis, and survival curves were compared between the groups with or without existing corresponding symptom clusters using the log-rank test. Results The following symptom clusters were identified: cluster 1 (pain, insomnia, emotional functioning), cluster 2 (dyspnea, appetite loss, fatigue, and nausea), and cluster 3 (physical functioning). Cronbach’s alpha values for the symptom clusters ranged from 0.72 to 0.82. An increased risk of death was significantly associated with the existence of cluster 2 and poor PPS (log-rank test, p = 0.016 and p < 0.001, respectively). Conclusion In terminally ill patients with cancer, three symptom clusters were detected based on QLQ-C15-PAL scores. Poor PPS and the presence of symptom cluster that includes dyspnea, appetite loss, fatigue, and nausea indicated poor prognosis.

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