Anxiety Disorders in Palliative Care

2014 ◽  
pp. 19-28
Author(s):  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Anxiety Disorders ◽  
Medical Condition ◽  
Terminally Ill ◽  
Adjustment Disorder ◽  
Assessment Tools ◽  
Pharmacological Agents ◽  
General Medical Condition ◽  
Severe Anxiety

Anxiety is common in palliative care patients and may significantly impact patients’ quality of life. Anxiety can have many etiologies resulting in different anxiety syndromes, ranging from adjustment disorder, anxiety resulting from general medical condition, to medication-induced anxiety disorders. Pre-existing anxiety disorders should also be taken into consideration in palliative care settings. Different screening and assessment tools have been used to improve recognition and assessment of anxiety in the terminally ill. Treatment of anxiety in this patient population includes use of a variety of pharmacological agents to relieve severe anxiety symptoms and use of psychotherapy interventions that have been shown to be safe and effective in the terminally ill. This chapter includes an overview of the prevalence, assessment, and management of anxiety disorders in palliative care settings.

Correlazioni positive tra spiritualità e salute: i risultati di alcune indagini / Positive correlations between spirituality and health: results from some surveys

2019 ◽  
Vol 68 (1) ◽  
pp. 41-54
Author(s):  
Paolo Morocutti
Keyword(s):  
Quality Of Life ◽  
Health Personnel ◽  
Medical Condition ◽  
Well Being ◽  
Close Correlation ◽  
General Medical Condition ◽  
Spirituality And Health ◽  
Positive Correlations ◽  
Positive Effect

La dimensione religiosa dell’uomo contribuisce in modo sostanziale al mantenimento della condizione medica generale, migliorando e preservando la qualità della vita. Quanto fa bene la fede? La preghiera fa ammalare meno e guarire prima? La partecipazione ai servizi religiosi porta realmente un effetto positivo sulla salute? Gli studi esaminati in questo articolo sembrano rispondere affermativamente a queste domande, evidenziando la stretta correlazione tra religiosità/spiritualità, salute e benessere fisico e psicologico. L’impatto antropologico e sociologico di tale realtà conduce ad evidenti riflessioni storiche e filosofiche, ma anche mediche e bioetiche, generando l’esigenza di una profonda trasformazione nella formazione del personale sanitario, dove l’aspetto religioso o spirituale non è ritenuto importante, né rilevante nell’approccio medico per la cura e l’assistenza del paziente. Nonostante ciò, numerosi studi approfondiscono ed attestano l’importanza di questo aspetto sia dei singoli, sia dell’intera popolazione. ---------- Religious dimension of man contributes substantially to maintain general medical condition, improving and preserving quality of life. How good is faith? Does prayer make you sick less and get better sooner? Does participation in religious services actually have a positive effect on health? The studies examined within this article seem to answer positively to these questions, highlighting the close correlation between religiosity / spirituality, health and physical and psychological well-being. The anthropological and sociological impact of this reality leads to evident historical and philosophical as well as medical and bioethical reflections, generating the need for a deep transformation of health personnel training, where the religious or spiritual aspect are not considered as important, nor relevant for medical approach to patient’s care. Nevertheless, several studies address and highlight the importance of this aspect for both individuals and whole population.

Prevalence and Predictors of Distress, Anxiety, Depression, and Quality of Life in Bereaved Family Caregivers of Patients With Advanced Cancer

2019 ◽  
Vol 37 (3) ◽  
pp. 201-213 ◽  
Author(s):  
Karin Oechsle ◽  
Anneke Ullrich ◽  
Gabriella Marx ◽  
Gesine Benze ◽  
Feline Wowretzko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Depressive Symptoms ◽  
Family Caregivers ◽  
Advanced Cancer ◽  
Anxiety Symptoms ◽  
Bereaved Family ◽  
Severe Anxiety ◽  
Item Scale

Objective: To investigate prevalence and predictors of postloss distress, depressive and anxiety symptoms, and quality of life among bereaved family caregivers of patients with advanced cancer. Methods: Prospective multicenter study. Family caregivers (N = 160, mean age 56.8 years, 66% female) completed validated outcome measures (Distress Thermometer, Generalized Anxiety Disorder 7-item scale, Patient Health Questionnaire depression module 9-item scale, SF-8 Health Survey Questionnaire) 6 months after patient’s discharge or death at specialist inpatient palliative care ward. Results: Clinically relevant distress was observed in 82% with sadness (89%), exhaustion (74%), sleeping problems (68%), loneliness (53%), and sorrows (52%) being the most common distress-causing problems. Moderate/severe anxiety and depressive symptoms were observed in 27% and 35%, respectively. Compared to an adjusted norm sample, quality of life was significantly impaired with exception of “bodily pain” and physical component score. Preloss caregiving (odds ratio [OR] 2.195) and higher preloss distress (OR 1.345) predicted high postloss distress. Utilization of psychosocial support services (OR 2.936) and higher preloss anxiety symptoms (OR 1.292) predicted moderate/severe anxiety symptoms, lower preloss physical quality of life (OR 0.952), and higher preloss depressive symptoms (OR 1.115) predicted moderate/severe depressive symptoms. Conclusion: Preloss mental burden showed to be a consistent predictor for postloss burden and should be addressed during palliative care. Future research should examine specific caregiver-directed interventions during specialist palliative care.

scholarly journals Evaluation of the Quality of Dying and Death Questionnaire in Kenya

2019 ◽  
pp. 1-16
Author(s):  
Kenneth Mah ◽  
Richard A. Powell ◽  
Carmine Malfitano ◽  
Nancy Gikaara ◽  
Lesley Chalklin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Assessment Tools ◽  
Treatment Preferences ◽  
Culturally Appropriate ◽  
Patient Centered ◽  
P Values ◽  
Quality Of Dying ◽  
Cancer Sample

PURPOSE A culturally appropriate, patient-centered measure of the quality of dying and death is needed to advance palliative care in Africa. We therefore evaluated the Quality of Dying and Death Questionnaire (QODD) in a Kenyan hospice sample and compared item ratings with those from a Canadian advanced-cancer sample. METHODS Caregivers of deceased patients from three Kenyan hospices completed the QODD. Their QODD item ratings were compared with those from 602 caregivers of deceased patients with advanced cancer in Ontario, Canada, and were correlated with overall quality of dying and death ratings. RESULTS Compared with the Ontario sample, outcomes in the Kenyan sample (N = 127; mean age, 48.21 years; standard deviation, 13.57 years) were worse on 14 QODD concerns and on overall quality of dying and death ( P values ≤ .001) but better on five concerns, including interpersonal and religious/spiritual concerns ( P values ≤ .005). Overall quality of dying was associated with better patient experiences with Symptoms and Personal Care, interpersonal, and religious/spiritual concerns ( P values < .01). Preparation for Death, Treatment Preferences, and Moment of Death items showed the most omitted ratings. CONCLUSION The quality of dying and death in Kenya is worse than in a setting with greater PC access, except in interpersonal and religious/spiritual domains. Cultural differences in perceptions of a good death and the acceptability of death-related discussions may affect ratings on the QODD. This measure requires revision and validation for use in African settings, but evidence from such patient-centered assessment tools can advance palliative care in this region.

Quality of life in terminally ill patients – a challenge for future research

2013 ◽  
Vol 21 (3) ◽  
Author(s):  
Cornelia Meffert ◽  
Gerhild Becker
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Studies ◽  
Palliative Medicine ◽  
Pain Therapy ◽  
Unsolved Problem ◽  
Terminally Ill ◽  
Future Research ◽  
Outcome Criterion

SummaryRecent statistics reveal a substantial and even growing need for palliative care in present-day society. Providing adequate pain therapy remains a largely unsolved problem, mainly because of the small number of clinical studies in palliative medicine. Hence, clinical research is urgently needed – and therefore suitable tools to measure outcomes must be developed. Contrary to typical clinical studies, the usual outcome parameters such as decreased mortality and/or morbidity are unsuitable. Future research should focus on developing an instrument which allows to measure quality of life as the central outcome criterion of clinical studies in palliative medicine.

scholarly journals Anxiety disorders and risk of stroke: A systematic review and meta-analysis

2017 ◽  
Vol 41 (1) ◽  
pp. 102-108 ◽  
Author(s):  
M. Pérez-Piñar ◽  
L. Ayerbe ◽  
E. González ◽  
R. Mathur ◽  
Q. Foguet-Boreu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anxiety Disorders ◽  
Critical Appraisal ◽  
Web Of Science ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Explanatory Factors ◽  
Increased Risk ◽  
Severe Anxiety

AbstractBackgroundAnxiety disorders are the most common mental health problem worldwide. However, the evidence on the association between anxiety disorders and risk of stroke is limited. This systematic review and meta-analysis presents a critical appraisal and summary of the available evidence on the association between anxiety disorders and risk of stroke.MethodsCohort studies reporting risk of stroke among patients with anxiety disorders were searched in PubMed, Embase, PsycINFO, Scopus, and the Web of Science, from database inception to June 2016. The quality of the studies was assessed using standard criteria. A meta-analysis was undertaken to obtain pooled estimates of the risk of stroke among patients with anxiety disorders.ResultsEight studies, including 950,759 patients, from the 11,764 references initially identified, were included in this review. A significantly increased risk of stroke for patients with anxiety disorders was observed, with an overall hazard ratio: 1.24 (1.09–1.41), P = 0.001. No significant heterogeneity between studies was detected and the funnel plot suggested that publication bias was unlikely. Limited evidence suggests that the risk of stroke is increased shortly after the diagnosis of anxiety and that risk of stroke may be higher for patients with severe anxiety.ConclusionsAnxiety disorders are a very prevalent modifiable condition associated with risk of stroke increased by 24%. This evidence could inform the development of interventions for the management of anxiety and the prevention of stroke. Further studies on the risk of stroke in patients with anxiety, and the explanatory factors for this association, are required.

Assessment tools for palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 66-66
Author(s):  
Sarina Isenberg ◽  
Rebecca Aslakson ◽  
Sydney Morss Dy ◽  
Renee Wilson ◽  
Julie Waldfogel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Quality Indicators ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Care Quality ◽  
Assessment Tools ◽  
Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

The Australian Palliative Care Outcomes Collaboration (PCOC) - measuring the quality and outcomes of palliative care on a routine basis

2010 ◽  
Vol 34 (2) ◽  
pp. 186 ◽  
Author(s):  
Kathy Eagar ◽  
Prue Watters ◽  
David C. Currow ◽  
Samar M. Aoun ◽  
Patsy Yates
Keyword(s):  
Palliative Care ◽  
Assessment Tools ◽  
Third Party ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Routine Basis ◽  
Palliative Care Services ◽  
Care Outcomes ◽  
Quality And Outcomes

Australia is leading the way in establishing a national system (the Palliative Care Outcomes Collaboration – PCOC) to measure the outcomes and quality of specialist palliative care services and to benchmark services across the country. This article reports on analysis of data collected routinely at point-of-care on 5939 patients treated by the first fifty one services that voluntarily joined PCOC. By March 2009, 111 services have agreed to join PCOC, representing more than 70% of services and more than 80% of specialist palliative care patients nationally. All states and territories are involved in this unique process that has involved extensive consultation and infrastructure and close collaboration between health services and researchers. The challenges of dealing with wide variation in outcomes and practice and the progress achieved to date are described. PCOC is aiming to improve understanding of the reasons for variations in clinical outcomes between specialist palliative care patients and differences in service outcomes as a critical step in an ongoing process to improve both service quality and patient outcomes. What is known about the topic?Governments internationally are grappling with how best to provide care for people with life limiting illnesses and how best to measure the outcomes and quality of that care. There is little international evidence on how to measure the quality and outcomes of palliative care on a routine basis. What does this paper add?The Palliative Care Outcomes Collaboration (PCOC) is the first effort internationally to measure the outcomes and quality of specialist palliative care services and to benchmark services on a national basis through an independent third party. What are the implications for practitioners?If outcomes and quality are to be measured on a consistent national basis, standard clinical assessment tools that are used as part of everyday clinical practice are necessary.

scholarly journals Definitions for “palliative care”, “end-of-life” and “terminally ill” in oncology: a scoping review

2020 ◽  
Vol 9 (2) ◽  
pp. 205-228
Author(s):  
Franciele Roberta Cordeiro ◽  
Stefanie Griebeler Oliveira ◽  
Juliana Zeppini Giudice ◽  
Vanessa Pellegrini Fernandes ◽  
Adriéli Timm Oliveira
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Scoping Review ◽  
Web Of Science ◽  
Functional Decline ◽  
Terminally Ill ◽  
Descriptive Statistics ◽  
Quality Of Death ◽  
Clinical Worsening

Objective: to identify and map the definitions for palliative care, end of life, and terminally ill in the oncology literature. Materials and method: scoping review guided by Joanna Brigs Institute recommendations. We analyzed original articles, published between 2012 and 2017, indexed in the databases Pubmed, Web of Science and Scopus. The data collection resulted in 51 articles selected for analysis. Also, we have consulted the websites of 25 palliative care societies from countries best ranked in The Economist’s Quality of Death Ranking. The data were analyzed through descriptive statistics, and summary of the themes, in this case the definitions. Results: terminally ill is a disease with a prognosis of lifetime ranging between hours and months, there is clinical worsening, functional decline, and presence of metastases. Palliative care aims to promote quality of life and dignity. End of life is the period of up to 12 months before death. Conclusions: we constructed synthesis and definitions for the concepts investigated. Thus, it was possible to contribute to the adoption of a standardized language in care and investigations with cancer patients in end-of-life

Challenging Symptoms

2017 ◽  
Author(s):  
Barton T. Bobb ◽  
Devon Fletcher
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Sleep Disorders ◽  
Assessment Tools ◽  
Dry Mouth ◽  
Advanced Practice ◽  
Medication Side Effects ◽  
Medication Side

Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. These symptoms can be challenging to treat, and they require that the advanced practice registered nurse (APRN) has a working knowledge of the causative conditions in order to effectively manage the symptoms. Appropriate assessment tools for these common symptoms are reviewed, as are their various causes, from medication side effects, systemic illness, and physical and psychological causes. Pharmacological, nonpharmacological, and interventional treatments are offered, with the caveat that all interventions must be individualized to the patient’s care goals and with quality of life in mind.

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