Symptom reduction in palliative care from single session mindful breathing: a randomised controlled trial

2020 ◽  
pp. bmjspcare-2020-002382 ◽  
Author(s):  
Mei Ling Look ◽  
Seng Beng Tan ◽  
Li Li Hong ◽  
Chong Guan Ng ◽  
Hway Ann Yee ◽  
...  
Keyword(s):  
Palliative Care ◽  
Standard Care ◽  
Controlled Trial ◽  
Symptom Assessment ◽  
Control Group ◽  
Single Session ◽  
Median Reduction ◽  
Palliative Care Setting ◽  
Edmonton Symptom Assessment Scale ◽  
Multiple Symptoms

ContextThere has been increasing evidence of the role of mindfulness-based interventions in improving various health conditions. However, the evidence for the use of mindfulness in the palliative care setting is still lacking.ObjectivesThe objective of our study was to determine the efficacy of a single session of 20 min mindful breathing in alleviating multiple symptoms in palliative care.MethodsAdult palliative care in patients with at least one symptom scoring ≥5/10 based on the Edmonton Symptom Assessment Scale (ESAS) were recruited from September 2018 to December 2018. Recruited patients were randomly assigned to either 20 min mindful breathing and standard care or standard care alone.ResultsForty patients were randomly assigned to standard care plus a 20 min mindful breathing session (n=20) or standard care alone (n=20). There was statistically significant reduction of total ESAS score in the mindful breathing group compared with the control group at minute 20 (U=98, n 1 = n 2 = 20, mean rank 1 = 15.4, mean rank 2 = 25.6, median reduction 1 = 6.5, median reduction 2 = 1.5, z=−2.763, r=0.3, p=0.005).ConclusionOur results provided evidence that a single session of 20 min mindful breathing was effective in reducing multiple symptoms rapidly for palliative care patients.

Cannabis use in palliative care: The prevalence and clinical characteristics.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 245-245
Author(s):  
Young Doo Chang ◽  
Joshua S. Smith ◽  
Ritika Oberoi-Jassal ◽  
Vijay Desai ◽  
Stephanie L Winn ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Characteristics ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
P Value ◽  
Spiritual Wellbeing ◽  
Care Clinic ◽  
Palliative Care Setting ◽  
Edmonton Symptom Assessment Scale ◽  
Drug Sample

245 Background: Cannabis has growing attention in palliative care, been used for some cancer related symptom burden, but limited data in terms of prevalence in palliative care setting and clinical characteristics with using it. Purpose: To identify the prevalence of positive rate of cannabis metabolite on urine drug sample (UDS) and compare clinical characteristics focused on symptoms burden on Edmonton Symptom Assessment Scale (ESAS) on the same day of UDS. Methods: We conducted retrospective medical records review of 919 consecutive supportive care clinic patients who were seen at a National Cancer Institute center during a 12-month period between 7/01/2015 to 6/30/2016. Results: 531 out of 919 patients were excluded because UDS was not ordered: either patients were established or had low risk of substance abuse by clinicians’ judgement. 2 patients did not complete ESAS on same day of UDS. 137 patients were excluded because of missing UDS results as well. Finally, 249 out of 919 patients were included for data analysis with their UDS and ESAS at same day of visit. 54 patients were positive for cannabis metabolite (THC: tetrahydrocannabinol) on UDS (22%). We found that positive cannabis group was younger (Mean age 56.1 vs 48.8, p-Value .001), reported higher score of total ESAS (Mean 45.5 vs 38.9, p-value 0.023), pain (Mean 6.13 vs 4.99, p-Value 0.007), and insomnia (6.04 vs 4.44, p-Value 0.001). In addition, positive cannabis group reported poorer overall wellbeing (5.43 vs 4.56, p-Value 0.015) and spiritual wellbeing (6.04 vs 4.44, p Value 0.040) compared to negative cannabis group. Conclusions: The positive results of cannabis on UDS may be a marker of greater symptom burden, in particular, pain, insomnia and poorer overall and spiritual wellbeing as assessed by ESAS patient’s self-reporting.

The Impact of Integrated Multidisciplinary Palliative Care Program on Symptoms in Patients at the Palliative Care Ward—An Audit and a Protocol of Prospective Controlled Investigation

2017 ◽  
Vol 32 (3-4) ◽  
pp. 87-88 ◽  
Author(s):  
Andreas Jülich ◽  
Thomas Spreu ◽  
Britta Buchhold ◽  
Taras Usichenko
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Symptom Control ◽  
Sample Size Calculation ◽  
Care Program ◽  
Symptom Assessment ◽  
University Hospital ◽  
Retrospective Audit ◽  
Edmonton Symptom Assessment Scale ◽  
The Impact

An integrated multidisciplinary palliative care (IMPC) program is a promising tool to improve symptom control in patients at the end of life. The aim was to study the feasibility of the IMPC program in patients at the palliative care (PC) ward. A retrospective audit, using the extended Edmonton Symptom Assessment Scale (ESAS), was conducted on the PC ward of the university hospital. Consecutive patients who were admitted for the IMPC program during 1 year were considered. One hundred forty-eight cases (93% with underlying cancer) were analyzed. The intensity of pain levels, nausea, vomiting, shortness of breath, and sleep disorders decreased at least by 50% ( P < .0001) during the 13 (median) days of IMPC. Integrated multidisciplinary PC program was associated with symptom improvements in patients at the PC ward. The information generated supports sample size calculation for a prospective controlled trial.

scholarly journals The Efficacy of a Single Session of 20-Minute Mindful Breathing in Reducing Dyspnea Among Patients With Acute Decompensated Heart Failure: A Randomized Controlled Trial

2020 ◽  
pp. 104990912093474 ◽  
Author(s):  
Diana Leh-Ching Ng ◽  
Chee-Shee Chai ◽  
Kok-Leng Tan ◽  
Kok-Han Chee ◽  
Yu-Zhen Tung ◽  
...  
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Standard Care ◽  
Acute Decompensated Heart Failure ◽  
Controlled Trial ◽  
Decompensated Heart Failure ◽  
Single Session ◽  
Randomized Controlled ◽  
Median Reduction ◽  
Dyspnea Score

Heart failure is the leading cause of morbidity and mortality worldwide. Standard treatment for heart failure includes pharmacotherapy and cardiac device implants. However, supportive approaches in managing dyspnea in heart failure are limited. This study aimed to test the efficacy of 20-minute mindful breathing in reducing dyspnea among patients admitted for acute decompensated heart failure. We conducted a parallel-group, non-blinded, randomized controlled trial of a single session of 20-minute mindful breathing plus standard care versus standard care alone among patients admitted for moderate to severe dyspnea due to acute decompensated heart failure, using the dyspnea score based on the Edmonton Symptom Assessment System (ESAS), at the Cardiology Unit of University Malaya Medical Centre in Malaysia. Thirty participants were randomly assigned to a single session of 20-minute mindful breathing plus standard care (n = 15) or standard care alone (n = 15), with no difference in their demographic and clinical characteristics. There was statistically significant reduction in dyspnea in the intervention group compared to the control group at minute 20 (U = 49.5, n1 = 15, n2 =15, median reduction in ESAS dyspnea score 1 = 2, median reduction in ESAS dyspnea score 2 = 0, mean rank 1 = 11.30, mean rank 2 = 19.70, z = −2.692, r = 0.4, P = 0.007). Our results provided evidence that a single session of 20-minute mindful breathing was efficacious in reducing dyspnea for patients admitted for acute decompensated heart failure.

scholarly journals Mobile Health to Improve Adherence and Patient Experience in Heart Transplantation Recipients: The mHeart Trial

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 463
Author(s):  
Mar Gomis-Pastor ◽  
Sonia Mirabet Perez ◽  
Eulalia Roig Minguell ◽  
Vicenç Brossa Loidi ◽  
Laura Lopez Lopez ◽  
...  
Keyword(s):  
Heart Transplantation ◽  
Patient Experience ◽  
Mobile Application ◽  
Standard Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Group Versus ◽  
Control Group ◽  
P Value ◽  
Adherence Score

Non-adherence after heart transplantation (HTx) is a significant problem. The main objective of this study was to evaluate if a mHealth strategy is more effective than standard care in improving adherence and patients’ experience in heart transplant recipients. Methods: This was a single-center, randomized controlled trial (RCT) in adult recipients >1.5 years post-HTx. Participants were randomized to standard care (control group) or to the mHeart Strategy (intervention group). For patients randomized to the mHeart strategy, multifaceted theory-based interventions were provided during the study period to optimize therapy management using the mHeart mobile application. Patient experience regarding their medication regimens were evaluated in a face-to-face interview. Medication adherence was assessed by performing self-reported questionnaires. A composite adherence score that included the SMAQ questionnaire, the coefficient of variation of drug levels and missing visits was also reported. Results: A total of 134 HTx recipients were randomized (intervention N = 71; control N = 63). Mean follow-up was 1.6 (SD 0.6) years. Improvement in adherence from baseline was significantly higher in the intervention group versus the control group according to the SMAQ questionnaire (85% vs. 46%, OR = 6.7 (2.9; 15.8), p-value < 0.001) and the composite score (51% vs. 23%, OR = 0.3 (0.1; 0.6), p-value = 0.001). Patients’ experiences with their drug therapy including knowledge of their medication timing intakes (p-value = 0.019) and the drug indications or uses that they remembered (p-value = 0.003) significantly improved in the intervention versus the control group. Conclusions: In our study, the mHealth-based strategy significantly improved adherence and patient beliefs regarding their medication regimens among the HTx population. The mHeart mobile application was used as a feasible tool for providing long-term, tailor-made interventions to HTx recipients to improve the goals assessed.

scholarly journals Impact of a residential program on the psychological needs, motivation and physical activity of obese adults: A controlled trial based on Self-Determination Theory

2018 ◽  
pp. 33-40
Author(s):  
Julie Boiché ◽  
Mathieu Gourlan ◽  
Léna Rubin
Keyword(s):  
Physical Activity ◽  
Repeated Measures ◽  
Standard Care ◽  
Controlled Trial ◽  
Self Determination Theory ◽  
Psychological Needs ◽  
Self Determination ◽  
Control Group ◽  
Obese Adults ◽  
Perceived Relatedness

Purpose: This study aimed to examine the increased benefits of a Self Determination Theory (SDT)-based motivational component on psychological needs’ fulfillment, self-determined motivation and Physical Activity (PA) of obese patients taking part in a rehabilitation program. Methods: Fourty-nine obese adults (mean age = 52 years, mean BMI = 38.25 kg/m2) attended a 3-week residential intervention. Patients in the Motivation group (n = 24) received a standard care plus SDT-based intervention (i.e., improved supervised PA sessions + a 1-hour motivational session). Patients in the Control group (n = 25) only benefited from standard care. Psychological needs and motivation were measured at baseline, at the end of the program and one month after. PA was measured at baseline and one month after the end of the program. Repeated measures ANOVAs were performed to compare the evolution of the variables between groups. Results: The results indicated that participants from both groups displayed significant changes in their perceived autonomy, relatedness, intrinsic motivation and integrated regulation between the beginning and the end of the program. Next, participants from both groups showed a decrease in perceived relatedness between the end of the program and one month after. Last, the participants from the Motivation group reported greater increase of their PA scores between the beginning of the program and one month after as compared to those in the Control group. Conclusions: Obesity interventions should integrate motivational components in order to promote behavior maintenance after programs have ended.

scholarly journals Effects of self-conditioning techniques in promoting weight loss in patients with severe obesity: a randomized controlled trial protocol

2017 ◽  
Vol 4 (1) ◽  
pp. 20 ◽  
Author(s):  
Simona Bo ◽  
Farnaz Rahimi ◽  
Bice Properzi ◽  
Giuseppe Regaldo ◽  
Ilaria Goitre ◽  
...  
Keyword(s):  
Weight Loss ◽  
Standard Care ◽  
Traditional Approach ◽  
Controlled Trial ◽  
Well Being ◽  
Control Group ◽  
Randomized Controlled ◽  
Rapid Induction ◽  
Conditioning Approach

<p><strong>Background:</strong> Obesity is a worldwide epidemic; most obese individuals who lose weight after lifestyle educative treatments, soon regain it. Our aim is to evaluate the effectiveness of a training to teach self-conditioning technique (self-hypnosis) added to standard care in determining weight loss compared with standard care in patients with obesity</p><p><strong>Methods: </strong>This randomized controlled open trial will recruit 120 obese patients (BMI 35-50 Kg/m<sup>2</sup>), aged 20-70 years. The control group will receive a traditional approach: diet + exercise + behavioral recommendations. The experimental group will receive self-conditioning techniques + traditional approach.</p><p>Three individual sessions of hypnosis with rapid-induction techniques will be administered by trained personnel. All the participants of both groups will be assessed at three, six, nine and twelve months after randomization. The primary outcome is weight loss difference between groups at 12 months after randomization; secondary outcomes are changes in adherence to dietetic and exercise recommendations, appetite and satisfaction/well-being, waist circumference and body fat, blood pressure and blood metabolic and inflammatory variables.</p><p><strong>Conclusions: </strong>The results of this trial will assess whether a self-conditioning approach, based on self-hypnosis, is able to help participants to modulate unhealthy patterns of eating and sustain weight loss in the long term.<strong></strong></p>

Development and Validation of a Modified Version of the Edmonton Symptom Assessment Scale in a Flemish Palliative Care Population

2011 ◽  
Vol 28 (7) ◽  
pp. 475-482 ◽  
Author(s):  
Patricia Claessens ◽  
Johan Menten ◽  
Paul Schotsmans ◽  
Bert Broeckaert
Keyword(s):  
Palliative Care ◽  
Symptom Assessment ◽  
Assessment Scale ◽  
Face Validity ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
The Face ◽  
Palliative Care Units ◽  
Symptom Assessment Scale ◽  
Development And Validation

Palliative cancer patients are faced with multiple symptoms that threaten their quality of life. To manage these symptoms, a reliable and valid way of registration is crucial. In this study, the Edmonton Symptom Assessment Scale (ESAS) has been translated, modified, and tested on content, face, criterion, construct validity, and internal consistency for patients admitted to Flemish palliative care units. These aspects are tested in a descriptive, comparative, longitudinal study based on 3 convenience samples. The first consisted of 8 palliative care experts. The second sample checked the face validity and consisted of 4 patients, 5 family members, and 5 nurses. The last sample involved 23 patients admitted to 3 Flemish palliative care units. Heedful of the “new-wave” vision on validity, the translated and altered ESAS seemed a suitable instrument for the symptom assessment of patients with cancer admitted to a palliative care unit.

The Nature stroke study; NASTRU - A randomised controlled trial of nature-based post-stroke fatigue rehabilitation

2019 ◽  
Author(s):  
Anna María Pálsdóttir ◽  
Kjerstin Stigmar ◽  
Bo Norrving ◽  
Patrik Grahn ◽  
Ingemar F Petersson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomised Controlled Trial ◽  
Standard Care ◽  
Controlled Trial ◽  
Perceived Value ◽  
Control Group ◽  
Post Stroke ◽  
Randomised Controlled

Abstract Fatigue is common after stroke and contributes to disability and impaired quality of life. Currently, there is insufficient evidence on the efficacy of any intervention for post-stroke fatigue. The aim of the study was to examine whether 10 weeks Nature-based rehabilitation (NRB) as add-on to standard care may improve post-stroke fatigue, perceived value of everyday occupations, function, activity and participation compared to standard care only (Clinical Trial.gov Identifier: NCT02435043, 2012/352, 05-06-2015). The study was carried out as a single blinded two-armed randomised controlled trial. Stroke survivors identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke > 1 year earlier) were randomised to Standard care + NBR or Standard care only. Blinded evaluations were conducted at follow-up 8 and 14 months after randomisation. The primary outcomes were post-stroke fatigue (Mental Fatigue Scale, total score) and perceived value of everyday occupations (Oval-pd) 8 months after randomisation. About a quarter of the screened patients were eligible; half accepted to participate and 101 were randomised, mean age 67 years, 60% female. The patients with sub-acute stroke were highly compliant with the intervention. Fatigue decreased to a value below the suggested cut-off for mental fatigue (<10.5) in the intervention group but not in the control group; no statistically significant differences were found though between the groups. Conclusion: NASTRU is the first randomised study on NBR for patients with post stroke fatigue. NBR was feasible and well tolerated. The study was underpowered due to difficulties in recruiting participants. No significant differences were detected between intervention and control group. A larger RCT is warranted. Keywords: clinical trial, enriched environment, everyday occupations, horticulture therapy, quality of life.

scholarly journals Patterns of Opioid Prescription, Use, and Costs Among Patients With Advanced Cancer and Inpatient Palliative Care Between 2008 and 2014

2019 ◽  
Vol 15 (1) ◽  
pp. e74-e83 ◽  
Author(s):  
Sriram Yennurajalingam ◽  
Zhanni Lu ◽  
Suresh K. Reddy ◽  
EdenMae C. Rodriguez ◽  
Kristy Nguyen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Symptom Assessment ◽  
Patient Characteristics ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Edmonton Symptom Assessment Scale ◽  
Symptom Assessment Scale ◽  
Symptom Changes

PURPOSE: An understanding of opioid prescription and cost patterns is important to optimize pain management for patients with advanced cancer. This study aimed to determine opioid prescription and cost patterns and to identify opioid prescription predictors in patients with advanced cancer who received inpatient palliative care (IPC). MATERIALS AND METHODS: We reviewed data from 807 consecutive patients with cancer who received IPC in each October from 2008 through 2014. Patient characteristics; opioid types; morphine equivalent daily dose (MEDD) in milligrams per day of scheduled opioids before, during, and after hospitalization; and in-admission opioid cost per patient were assessed. We determined symptom changes between baseline and follow-up palliative care visits and the in-admission opioid prescription predictors. RESULTS: A total of 714 (88%) of the 807 patients were evaluable. The median MEDD per patient decreased from 150 mg/d in 2008 to 83 mg/d in 2014 ( P < .001). The median opioid cost per patient decreased and then increased from $22.97 to $40.35 over the 7 years ( P = .03). The median MEDDs increased from IPC to discharge by 67% ( P < .001). The median Edmonton Symptom Assessment Scale pain improvement at follow-up was 1 ( P < .001). Younger patients with advanced cancer (odds ratio [OR[, 0.95; P < . 001) were prescribed higher preadmission MEDDs (OR, 1.01; P < .001) more often in the earlier study years (2014 v 2009: OR, 0.18 [ P = .004] v 0.30 [ P = .02]) and tended to use high MEDDs (> 75 mg/d) during hospitalization. CONCLUSION: The MEDD per person decreased from 2008 to 2014. The opioid cost per patient decreased from 2008 to 2011 and then increased from 2012 to 2014. Age, prescription year, and preadmission opioid doses were significantly associated with opioid doses prescribed to patients with advanced cancer who received IPC.

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