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.

scholarly journals Prognostic Factors in Advanced Cancer Patients: Evidence-Based Clinical Recommendations—A Study by the Steering Committee of the European Association for Palliative Care

2005 ◽  
Vol 23 (25) ◽  
pp. 6240-6248 ◽  
Author(s):  
Marco Maltoni ◽  
Augusto Caraceni ◽  
Cinzia Brunelli ◽  
Bert Broeckaert ◽  
Nicholas Christakis ◽  
...  
Keyword(s):  
Palliative Care ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
European Association ◽  
Prognostic Scores ◽  
Evidence Based ◽  
Advanced Cancer Patients ◽  
Clinical Recommendations ◽  
Biologic Factors

PurposeTo offer evidence-based clinical recommendations concerning prognosis in advanced cancer patients.MethodsA Working Group of the Research Network of the European Association for Palliative Care identified clinically significant topics, reviewed the studies, and assigned the level of evidence. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic electronic literature search within the main available medical literature databases was performed for each of the following four areas identified: clinical prediction of survival (CPS), biologic factors, clinical signs and symptoms and psychosocial variables, and prognostic scores. Only studies on patients with advanced cancer and survival ≤ 90 days were included.ResultsA total of 38 studies were evaluated. Level A evidence-based recommendations of prognostic correlation could be formulated for CPS (albeit with a series of limitations of which clinicians must be aware) and prognostic scores. Recommendations on the use of other prognostic factors, such as performance status, symptoms associated with cancer anorexia-cachexia syndrome (weight loss, anorexia, dysphagia, and xerostomia), dyspnea, delirium, and some biologic factors (leukocytosis, lymphocytopenia, and C-reactive protein), reached level B.ConclusionPrognostication of life expectancy is a significant clinical commitment for clinicians involved in oncology and palliative care. More accurate prognostication is feasible and can be achieved by combining clinical experience and evidence from the literature. Using and communicating prognostic information should be part of a multidisciplinary palliative care approach.

Management of Fatigue in Palliative Care Settings

2014 ◽  
pp. 81-88
Author(s):  
William S. Breitbart
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Terminally Ill ◽  
Contributing Factors ◽  
Advanced Cancer Patients ◽  
Comprehensive Overview ◽  
Patients Experience

Fatigue is highly prevalent in palliative care settings. Studies suggest that as many as 60% to 90% of advanced cancer patients experience fatigue. Fatigue is frequently under-recognized and undertreated in the terminally ill. This chapter provides a comprehensive overview of the prevalence of fatigue in palliative care settings, instruments used in screening and assessment of fatigue, common contributing factors of fatigue in advanced cancer patients, and the most recent evidence on the strategies for management of fatigue in palliative care settings.

Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

2021 ◽  
pp. 104990912110178
Author(s):  
Abigail Sy Chan ◽  
Amit Rout ◽  
Christopher R. D.’Adamo ◽  
Irina Lev ◽  
Amy Yu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Length Of Hospital Stay ◽  
Inpatient Setting ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Early Palliative Care ◽  
Code Status ◽  
Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

Differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units: A multicenter prospective cohort study (EASED)

2021 ◽  
pp. 026921632198956
Author(s):  
Takahiro Higashibata ◽  
Takayuki Hisanaga ◽  
Shingo Hagiwara ◽  
Miho Shimokawa ◽  
Ritsuko Yabuki ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Advanced Cancer Patients ◽  
Appropriate Use ◽  
Palliative Care Units ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Background: Studies on the appropriate use of urinary catheters for cancer patients at the end of life are limited. Aim: To clarify the differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units. Design: Pre-planned secondary analysis of a multicenter, prospective cohort study; East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). Setting/participants: This study enrolled consecutive advanced cancer patients admitted to palliative care units between January and December 2017. The final study group comprised 1212 patients from 21 institutions throughout Japan. Results: Out of the 1212 patients, 380 (31.4%; 95% confidence interval, 28.7%–34.0%) underwent urinary catheterization during their palliative care unit stay, and the prevalence of urinary catheterization in patients who died at palliative care units by institution ranged from 0.0% to 55.4%. When the 21 participating institutions were equally divided into three groups according to the institutional prevalence of catheterization, patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation were more likely to be catheterized in institutions with a high prevalence of catheterization than in those with a low or moderate prevalence ( p < 0.008, p = 0.008, and p < 0.008, respectively). Conclusion: This study revealed that the institutional prevalence of urinary catheterization in advanced cancer patients at palliative care units widely varied. Further studies are needed to establish the appropriate use of urinary catheters, especially in patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation.

scholarly journals Palliative Care and COVID-19 Pandemic: Retrospective Study of Factors Associated With Infection and Death at an Oncological Palliative Care Reference Center

2021 ◽  
pp. 104990912098696
Author(s):  
Livia Costa de Oliveira ◽  
Karla Santos da Costa Rosa ◽  
Ana Luísa Durante ◽  
Luciana de Oliveira Ramadas Rodrigues ◽  
Daianny Arrais de Oliveira da Cunha ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Tumor Type ◽  
Advanced Cancer Patients ◽  
Factors Associated ◽  
Reactive Protein

Background: Advanced cancer patients are part of a group likely to be more susceptible to COVID-19. Aims: To describe the profile of advanced cancer inpatients to an exclusive Palliative Care Unit (PCU) with the diagnosis of COVID-19, and to evaluate the factors associated with death in these cases. Design: Retrospective cohort study with data from advanced cancer inpatients to an exclusive PCU, from March to July 2020, with severe acute respiratory syndrome. Diagnostic of COVID-19 and death were the dependent variables. Logistic regression analyses were performed, with the odds ratio (OR) and 95% confidence interval (CI). Results: One hundred fifty-five patients were selected. The mean age was 60.9 (±13.4) years old and the most prevalent tumor type was breast (30.3%). Eighty-three (53.5%) patients had a diagnostic confirmation of COVID-19. Having diabetes mellitus (OR: 2.2; 95% CI: 1.1-6.6) and having received chemotherapy in less than 30 days before admission (OR: 3.8; 95% CI: 1.2-12.2) were associated factors to diagnosis of COVID-19. Among those infected, 81.9% died and, patients with Karnofsky Performance Status (KPS) < 30% (OR: 14.8; 95% CI 2.7-21.6) and C-reactive protein (CRP) >21.6mg/L (OR: 9.3; 95% CI 1.1-27.8), had a greater chance of achieving this outcome. Conclusion: Advanced cancer patients who underwent chemotherapy in less than 30 days before admission and who had diabetes mellitus were more likely to develop Coronavirus 2019 disease. Among the confirmed cases, those hospitalized with worse KPS and bigger CRP were more likely to die.

Efficacy of Guided Imagery With Theta Music for Advanced Cancer Patients With Dyspnea: A Pilot Study

2010 ◽  
Vol 12 (2) ◽  
pp. 188-197 ◽  
Author(s):  
Wei-Shu Lai ◽  
Co-Shi Chantal Chao ◽  
Wan-Ping Yang ◽  
Ching-Huey Chen
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Repeated Measures ◽  
Qualitative Data ◽  
Guided Imagery ◽  
Low Cost ◽  
Borg Scale ◽  
Advanced Cancer Patients ◽  
End Tidal

Background: Dyspnea is a frequent and devastating symptom among advanced cancer patients for which improved and low-cost palliative techniques are needed.Methods: A one-group repeated measures research design investigated the efficacy of guided imagery (GI) with theta music (θM) on dyspnea in advanced cancer patients. The intervention consisted of four periods: (a) pretest; (b) intervention with peaceful non-θM; (c) intervention with 10 min of GI with θM (GI/θM), with the first and last 3 min being θM only (i.e., the middle 4 min was GI/θM); and (d) posttest. Dyspnea outcome was measured with the Modified Borg Scale (MBS) for self-reported evaluation of dyspneic symptoms. Physiological parameters measured were pulse oxygen saturation (SpO2), end-tidal CO2(EtCO2), heart rate (HR), and respiratory rate (RR). Posttest qualitative data were obtained via interview for subjective patient experience.Results: Participants included 53 patients, 33% with lung cancer. GI/θM produced a significant decrease in MBS scores; 90% of the subjects gave positive qualitative reviews of GI/θM. SpO2did not change significantly over time. GI/θM significantly increased EtCO2, decreased RR, and decreased HR.Discussion: This study demonstrates that GI/θM is a useful intervention for palliative care of patients with dyspnea. θM alone was demonstrated to be effective, while soothing non-θM was not effective. GI/θM was more effective than θM alone. GI/θM should be considered low-cost end-of-life palliative care for dyspnea.

Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care

2017 ◽  
Vol 26 (3) ◽  
pp. 913-919 ◽  
Author(s):  
Sebastiano Mercadante ◽  
Francesco Masedu ◽  
Isabella Balzani ◽  
Daniela De Giovanni ◽  
Luigi Montanari ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Advanced Cancer Patients
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