Palliative medicine in the emergency department: symptom control and aggressive care

2021 ◽  
pp. bmjspcare-2021-003332
Author(s):  
Raquel de Oliveira ◽  
Carolina B. Lobato ◽  
Leonardo Maia-Moço ◽  
Mariana Santos ◽  
Sara Neves ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Symptom Control ◽  
Well Being ◽  
Blood Collection ◽  
Intravenous Fluid Therapy ◽  
Aggressive Care ◽  
Aggressive Interventions ◽  
Time Of Admission

ObjectivesIdentifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.MethodsWe conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.Results384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.ConclusionsNearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.

scholarly journals Palliative Curriculum Re-imagined: A Critical Evaluation of the UK Palliative Medicine Syllabus

2018 ◽  
Vol 11 ◽  
pp. 117822421878037
Author(s):  
Julian Abel ◽  
Allan Kellehear
Keyword(s):  
Public Health ◽  
Social Support ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Critical Evaluation ◽  
Well Being ◽  
Disease Models ◽  
Care Policy ◽  
The Uk ◽  
Illness And Disease

The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.

scholarly journals Upside down solutions: palliative care and COVID-19

2020 ◽  
pp. bmjspcare-2020-002385 ◽  
Author(s):  
Daniel Knights ◽  
Felicity Knights ◽  
Iain Lawrie
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Well Being ◽  
Models Of Care ◽  
Resource Limited ◽  
Relief Of Suffering ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Effective Use

The current COVID-19 pandemic is unprecedented and requires innovation beyond existing approaches to contribute to global health and well-being. This is essential to support the care of people at the end of their lives or who are critically ill from COVID-19 or other life-limiting illnesses. Palliative care (PC) is centred on effective symptom control, promotion of quality of life, complex decision-making, and holistic care of physical, psychological, social and spiritual health. It is ideally placed to both provide and contribute to care for patients, families, communities and colleagues during the pandemic. Where recovery is uncertain, emphasis should be on care and relief of suffering, as well as survival. Where healthcare resources and facilities come under intense pressure, lessons can be learnt from models of care in other settings around the world. This article explores how the field can contribute by ensuring that PC principles and practices are woven into everyday healthcare practice. We explore alternative ways of providing care under such pressure and discuss three areas of learning from resource-limited settings: (1) integration of palliative medicine into everyday practice, (2) simplification of biomedical management plus multidisciplinary teamwork and (3) effective use of volunteers.

Quality improvement outcomes in an academic practice participating in ASCO’s Quality Oncology Practice Initiative (QOPI).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 206-206
Author(s):  
Mary Anne Fenton
Keyword(s):  
Palliative Care ◽  
Quality Control ◽  
Quality Improvement ◽  
Primary Care Physicians ◽  
Symptom Control ◽  
Well Being ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Academic Practice ◽  
Improvement Interventions

206 Background: The ASCO QOPI is an instrument for community and academic practices to assess quality and adherence to guidelines in areas of treatment planning and goals, chemotherapy consent documentation, smoking cessation, symptom control, palliative care, and disease specific measures. Following data submission QOPI summary reports for the submitting practice and QOPI aggregate are available for review and comparison. Methods: The academic practice of Rhode Island Hospital Comprehensive Cancer Center has participated in QOPI since the fall of 2008. QOPI measure summary reports for our practice and comparison to the Academic Aggregate are reviewed by our physicians after each round of chart abstraction, measures are identified for improvement. Interventions include education on practice improvement and development of policy and procedures for implementation by our Quality Control Officer in compliance with hospital policies. Results: Presented is a summary of quality improvement interventions implemented. Additional areas of quality improvement have been identified based on QOPI data, and improvement plans are ongoing including treatment summaries for patient and primary care physicians, tools to assess patient emotional well being, documentation of family history and referral for genetic assessment. Conclusions: QOPI provides a platform for collection, analysis and comparison of quality measures. For the measures of formulating a pain plan the intervention was a reminder to document the plan. For the measure hospice enrollment, a reflection on our hospice enrollment has lead to an increase in referral to palliative care. The ASCO QOPI program is a tool for quality improvement, our Quality Control Officer was essential in implementation of our improvement projects. [Table: see text]

Paediatric Palliative Medicine

2016 ◽  
Author(s):  
Richard Hain ◽  
Satbir Jassal
Keyword(s):  
Palliative Care ◽  
Health Care Professionals ◽  
Palliative Medicine ◽  
Symptom Control ◽  
Reference Drug ◽  
Paediatric Palliative Care ◽  
Management Plans ◽  
Concise Information ◽  
And Coping ◽  
Reference Tool

Looking after children with life-limiting conditions can be very difficult for both parents and health-care professionals. This second edition of Paediatric Palliative Medicine is full of easily accessible, detailed information on medical conditions and symptoms, and includes specific management plans in order to guide the practising clinician through treatment of children requiring palliative care. Using the bestselling Oxford Specialist Handbook format to deliver practical and concise information, this handbook facilitates bedside delivery of effective palliative medicine. It includes detailed information on symptom control and the philosophy and models that support delivery of palliative medicine to children, while also covering practical delivery of palliative medicine relating to other professionals and families, and the learning and coping skills required in palliative care. It also contains a quick-reference drug formulary. Fully updated with an expanded formulary and a new chapter on the intensive care unit, this new edition continues to be the authoritative reference tool in paediatric palliative care.

Palliative care as a predictor of healthcare resource use at end-of-life in adult Albertan lung cancer decedents between 2008-2015: A secondary data analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24009-e24009
Author(s):  
Nureen Sumar ◽  
Madalene Earp ◽  
Desiree Hao ◽  
Aynharan Sinnarajah
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
End Of Life ◽  
Resource Use ◽  
Healthcare Resource ◽  
Strong Association ◽  
Specialist Palliative Care ◽  
Healthcare Resource Use ◽  
Aggressive Care ◽  
Aggressive Interventions

e24009 Background: Early utilization of specialist palliative care (SPC) in cancer patients may reduce healthcare resource use, aggressive interventions, and costs at end-of-life. We evaluated the impact of SPC on healthcare resource utilization and aggressive interventions at end-of-life in patients who have died from lung cancer. Methods: Descriptive and multivariable logistic regression analyses were conducted on lung cancer decedents in the Calgary Zone, Alberta Health Services from 2008 to 2015. The primary exposure was timing of SPC (Early: receipt of SPC > = 90 days before death; Late: < 90 days before death; No SPC). The primary outcome was end-of-life healthcare resource use (defined as any of: hospital death, > 1 emergency department visit, > 1 hospital admission, > 14 days of hospitalization, ≥1 intensive care unit admission, ≥1 new chemotherapy program (or any chemotherapy in the last 14 days of life) in the 30 days prior to death. Results: There were 3300 patients of which the majority (51.6%) of decedents were male. More female versus male lung cancer decedents (36.4% vs 28.7%) received early SPC. After adjusting for confounders, a strong association was found between early, late or no SPC and end-of-life healthcare resource use (ORno exposure 3.25 (95% CI 2.41-4.40) vs ORlate exposure 2.44 (95% CI 2.03-2.92) compared to those with early SPC; p < 0.001). Males had 1.53 the odds of aggressive care at end-of-life compared to females (p < 0.001). Stratified analysis by sex revealed a strong association between the absence of SPC utilization and end-of-life healthcare resource use. Young age ( < 50 at death) was a strong driver of aggressive care at end-of-life in females versus males [OR 5.44 vs 2.53]. Conclusions: Early specialist palliative care was significantly associated with less end-of-life healthcare resource use in both male and female lung cancer decedents, with less early specialist palliative care use in males. Keywords: palliative care, early palliative care, cancer, end-of-life, healthcare resource use, lung cancer.

scholarly journals Management of oncology-related emergencies at the emergency department: A long-term undertaking

2020 ◽  
pp. 102490792095367
Author(s):  
Wei Lin Tallie Chua ◽  
Shi En Joanna Chan ◽  
Gillianne Lai ◽  
Looi Yee Tracy Yong ◽  
Ravindran Kanesvaran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Early Warning ◽  
Hospital Setting ◽  
Well Being ◽  
Clinical Severity ◽  
Equal Distribution ◽  
Singapore General Hospital ◽  
Number Of Patients ◽  
Early Warning Scores

Background: The emergency department at the Singapore General Hospital is an emergency department with an annual census of 140,000 and oncology-related attendances of about 4000 (2.8%). These patients are often admitted for further care. Palliative care in the emergency department for these patients is often minimal. The aim of this study was to determine the state of current management of oncology-related emergencies at the Singapore General Hospital’s emergency department, hence identifying specific areas for intervention. Methods: We carried out a retrospective data review of all Singapore General Hospital’s emergency department patients who had either cancer-related diagnoses or were admitted to the Medical Oncology Department in October 2018. Simple statistical analysis was then performed using IBM SPSS version 21. Results: Of 308 identified patients, there was approximately equal distribution by sex. The women were generally younger than the men (61.33 ± 13.63 years vs 67.36 ± 12.02 years, p = 0.063, confidence interval −8.94 to −3.13). Seventy-two (23.4%) of the patients arrived at emergency department by ambulance. The mean emergency department length of stay was 4.25 h. About half of the patients had either lung, colorectal, or breast as their primary site of cancer. There was no correlation between clinical severity according to the National Early Warning Scores and triage complaint-type or emergency clinical diagnosis. More than 90% were admitted, with about 32.6% dying during their inpatient stay. High National Early Warning Scores were significantly associated with mortality. Conclusion: There is large potential for interventions to improve patient well-being in the pre-hospital setting and emergency department. Given the sizable number of patients with poor outcomes, palliative care is also of paramount importance.

Spirituality, quality of life, and locus of control in a palliative care setting

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18529-18529
Author(s):  
P. H. Thaker ◽  
C. Sun ◽  
D. C. Bodurka ◽  
J. Palmer ◽  
B. Pei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Locus Of Control ◽  
Internal Control ◽  
Pearson Correlation ◽  
Symptom Control ◽  
Well Being ◽  
Self Report ◽  
Palliative Care Setting

18529 Background: A patient’s spirituality/religious beliefs have a profound role on how one copes with disease & on quality of life (QOL). Perceptions of control play an important role in coping not only with stressful experiences, but also in health outcomes. Therefore, the primary objective was to determine whether patients’ spirituality/ religiosity correlates with quality of life and locus of control. Methods: As part of a pilot study, pts presenting for initial outpatient evaluation in the Department of Symptom Control & Palliative Care were enrolled and completed self-report measures: Functional Assessment of Chronic Illness Therapy-General (FACT-G), FACT-Spiritual Well-Being Scale (FACT-Sp), Duke University Religion Index (DUREL), Locus of Control (LOC), Herth Hope Scale (HHS), Predestination (PDQ), and Hospital Anxiety & Depression Scale (HADS). LOC contained 3 subscales: perceived occurrence of chance, dependence on powerful others, and internal control. Pearson correlation coefficients were calculated to explore the relationship between measures. The Mann-Whitney t-test was used to compare patient scores. Results: One hundred patients (48 men & 52 women) completed the surveys & 90% reported a Christian affiliation. QOL was positively correlated with FACT-Sp (p ≤ 0.001, r = .614) and the DUREL which measures both external/internal religiosity (p ≤ .01, r = .291). Interestingly, there was no gender difference in spirituality as measured by FACT-Sp; however, by the DUREL women engaged more frequently in private religious activity when compared with men (p < 0.001). Men had more perceived internal control with less emphasis on the occurrence of chance events or dependence on powerful others on LOC (p = 0.07), as well as a positive correlation with controlling of one’s own fate as measured by the PDQ (p = 0.1). Conclusions: As oncologists committed to providing comprehensive care, we need to be receptive to the spiritual needs of our patients since it augments their QOL and to empower them to have a sense of control. Future studies need to further define these complex relationships and to recognize possible gender differences. No significant financial relationships to disclose.

Palliative care: not only for treating symptoms: a case report

2020 ◽  
Vol 106 (6) ◽  
pp. NP1-NP4
Author(s):  
Maria Caterina Pallotti ◽  
Marianna Ricci ◽  
Romina Rossi ◽  
Lorenzo Cecconetto ◽  
Domenico Barone ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Palliative Care ◽  
Therapeutic Option ◽  
Symptom Control ◽  
Eastern Cooperative Oncology Group ◽  
Well Being ◽  
Molecular Characteristics ◽  
Gasserian Ganglion ◽  
Spiritual Well Being ◽  
Good Clinical Condition

Introduction: Palliative care (PC) aims to treat symptoms independently of the disease. In many medical disciplines, including oncology, there is an emphasis on personalizing treatment, identifying the most effective therapeutic option by studying the genetic heritage of the patient and the molecular characteristics of the disease. PC, on the other hand, encompasses the overall (physical and spiritual) well-being of the patient and his or her caregivers. The increasing use of early PC and its integration with oncology could represent a fruitful collaboration among specialists. Case description: We present the case of a 79-year-old woman with advanced breast cancer attending our institute who was referred to our PC Unit because of continuous ear pain, paresthesia around the mouth, strabismus, and facial dysesthesia. The patient was in good clinical condition (Eastern Cooperative Oncology Group 1) and was undergoing chemotherapy at the time. For these reasons, the PC physician carefully assessed the pain characteristics and differential diagnosis and discussed them with the oncologist, radiologist, and neurologist. Joint consultation led to a specific study of Meckel cave by MRI, revealing an extrameningeal gasserian ganglion metastasis, a very rare localization of breast cancer. Conclusion: We present a case that underlines the importance of specialized PC assessment not limited to the control of symptoms. The search for the etiopathogenesis of a patient’s symptoms and the evaluation of overall clinical conditions may be necessary to plan appropriate diagnostic evaluations, target palliative therapies, and achieve effective symptom control.

scholarly journals Is the Emergency Department an Inappropriate Venue for Code Status Discussions?

2020 ◽  
pp. 104990912093833
Author(s):  
Daniel G. Miller ◽  
J. Priyanka Vakkalanka ◽  
Morgan B. Swanson ◽  
Andrew S. Nugent ◽  
Yuya Hagiwara
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Improvement ◽  
Relative Risk ◽  
Early Recognition ◽  
Code Status ◽  
Before And After ◽  
Aggressive Care ◽  
Time Of Admission ◽  
Dnr Orders

Background: Historically, it has been assumed that the Emergency Department (ED) is a place for maximally aggressive care and that Emergency Medicine Providers (EMPs) are biased towards life-prolonging care. However, emphasis on early recognition of code status preferences is increasingly making the ED a venue for code status discussions (CSDs). In 2018, our hospital implemented a policy requiring EMPs to place a code status order (CSO) for all patients admitted through the ED. We hypothesized that if EMPs enter CSDs with a bias toward life-prolonging care, or if the venue of the ED biases CSDs towards life-prolonging care, then we would observe a decrease in the percentage of patients selecting DNR status following our institution’s aforementioned CSO mandate. Methods: We present a retrospective analysis of rates of DNR orders placed for patients admitted through our ED comparing six-month periods before and after the implementation of the above policy. Results: Using quality improvement data, we identified patients admitted through the ED during pre (n=7,858) and post (n=8,069) study periods. We observed the following: after implementation DNR preference identified prior to hospital admission from the ED increased from 0.4% to 5.3% (relative risk (RR) 12.5; 95% CI: 5.2-29.9), defining CS in the ED setting at the time of admission increased from 2.4% to 98.6% (p <0.001), and DNR orders placed during inpatient admission was unchanged (RR=0.97 (95% CI = 0.88-1.07)). Discussion: Our results suggest that the ED can be an appropriate venue for CSDs.

Tinjauan sistematis: Efektifitas Palliative Home Care untuk Pasien dengan HIV/AIDS

1970 ◽  
Vol 5 (1) ◽  
Author(s):  
Linlin Lindayani ◽  
Nenden Nur Asriyani Maryam
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Palliative Medicine ◽  
Cochrane Library ◽  
Palliative Home Care ◽  
Hiv Aids

Asuhan palitif untuk pasien dengan HIV/AIDS merupakan elemen inti dari asuhan pasien dengan HIV/AIDS. Asuhan paliatif yang berbasis home care saat ini menjadi elemen penting yang digunakan di berbagainegara. Akan tetapi, tidak ada studi atau tinjauan sebelumnya yang menganalisis efektifitas dari asuhanpaliatif yang berbasis home care pada pasien dengan HIV/AIDS. Tujuan dari tinjauan sistematik ini adalahuntuk mengevaluasi efektivitas Palliative Home Care untuk pasien dengan HIV/AIDS terhadap nyeri,pengendalian gejala, meningkatkan kualitas hidup, meningkatkan kepuasan asuhan, dan efektivitas biaya.Pencarian awal terbatas dilakukan di MEDLINE dan CINAHL. Kedua database tersebut dipilih denganpertimbangan bahwa keduanya merupakan database terbesar di bidang kesehatan dan kedokteran. Kemudiastrategi pencarian lainnya dilakukan pada database lain meliputi: Cochrane Library, UpToDate, Ovid, AIDSCare, Journal of Palliative Care, dan Journal of Palliative Medicine. Studi yang diterbitkan dalam Bahasa Inggrisdan tahun 2000-2016 dipertimbangkan untuk dimasukkan dalam tinjauan ini. Data diekstrak oleh penulis dandiringkas menggunakan alat ekstraksi data dari JBI (Joanna Briggs Institute). Kami menemukan 4 studi yangmasuk kedalam kriteria tinjauan kami, satu studi randomizes control trial dan tiga studi prospectively control.Hasil dari tinjauan ini menunjukkan bahwa Palliative Home Care terbukti efektif dalam mengontol nyeridan gejala-gelaja lain, mempertahankan dan meningkatkan kualitas hidup pasien, tingginya kepuasan daripasien dan kelurga terhadap asuhan Palliative Home Care berkisar 93% - 96% dan lebih cost-effectivenessdibandingkan dengan Hospital-Based Palliative Care. Dengan demikian, penting untuk mengembangkanPalliative Home Care untuk pasien dengan HIV/AIDS terutama untuk negara dengan sumber daya yang terbatas.

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