Symptom Control during the Last Week of Life on a Palliative Care Unit

1991 ◽  
Vol 7 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Robin Fainsinger ◽  
Melvin J. Miller ◽  
Eduardo Bruera ◽  
John Hanson ◽  
Tara Maceachern
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Palliative Care Unit

scholarly journals Experience of symptom control, anxiety and associating factors in a palliative care unit evaluated with Support Team Assessment Schedule Japanese version

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tetsuya Ito ◽  
Emi Tomizawa ◽  
Yuki Yano ◽  
Kiyozumi Takei ◽  
Naoko Takahashi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Laboratory Data ◽  
Japanese Version ◽  
Palliative Care Unit ◽  
Current Status ◽  
Physical Factors ◽  
Patient Anxiety ◽  
Team Assessment ◽  
Support Team

AbstractVarious physical and psychosocial difficulties including anxiety affect cancer patients. Patient surroundings also have psychological effects on caregiving. Assessing the current status of palliative care intervention, specifically examining anxiety and its associated factors, is important to improve palliative care unit (PCU) patient quality of life (QOL). This study retrospectively assessed 199 patients admitted to a PCU during August 2018–June 2019. Data for symptom control, anxiety level, disease insight, and communication level obtained using Support Team Assessment Schedule Japanese version (STAS-J) were evaluated on admission and after 2 weeks. Palliative Prognostic Index (PPI) and laboratory data were collected at admission. Patient anxiety was significantly severer and more frequent in groups with severer functional impairment (p = 0.003) and those requiring symptom control (p = 0.006). Nevertheless, no relation was found between dyspnea and anxiety (p = 0.135). Patients with edema more frequently experienced anxiety (p = 0.068). Patient survival was significantly shorter when family anxiety was higher after 2 weeks (p = 0.021). Symptoms, edema, and disabilities in daily living correlate with patient anxiety. Dyspnea is associated with anxiety, but its emergence might be attributable mainly to physical factors in this population. Family members might sensitize changes reflecting worsened general conditions earlier than the patients.

scholarly journals Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System

2005 ◽  
Vol 30 (4) ◽  
pp. 367-373 ◽  
Author(s):  
Caterina Modonesi ◽  
Emanuela Scarpi ◽  
Marco Maltoni ◽  
Stefania Derni ◽  
Laura Fabbri ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Symptom Assessment ◽  
Assessment System ◽  
Palliative Care Unit ◽  
Edmonton Symptom Assessment System

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.

scholarly journals Learning a palliative care approach during the COVID-19 pandemic: A case study in an Infectious Diseases Unit

2020 ◽  
Vol 34 (9) ◽  
pp. 1220-1227 ◽  
Author(s):  
S Tanzi ◽  
S Alquati ◽  
G Martucci ◽  
L De Panfilis
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Symptom Relief ◽  
Symptom Control ◽  
Palliative Care Unit ◽  
Delivery Of Care ◽  
Team Meetings ◽  
Palliative Care Teams ◽  
Using Data

Background: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. Aim: The aim of the study was to describe a palliative care unit’s consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. Design: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. Setting/participants: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. Results: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study. Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. Conclusion: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients’ use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.

Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit

2015 ◽  
Vol 13 (6) ◽  
pp. 1781-1785
Author(s):  
Julio Silvestre ◽  
Maria Montoya ◽  
Eduardo Bruera ◽  
Ahmed Elsayem
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Congestive Heart Failure ◽  
Performance Status ◽  
Symptom Control ◽  
Palliative Care Unit ◽  
Team Approach ◽  
Dramatic Improvement ◽  
Do Not Resuscitate ◽  
End Stage

AbstractObjective:We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting.Method:We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided.Results:Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control.Significance of Results:This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.

Characterisation of palliative sedation use in inpatients at a medium-stay palliative care unit

2020 ◽  
Vol 26 (7) ◽  
pp. 341-345
Author(s):  
Efrén Murillo-Zamora ◽  
Nallely A García-López ◽  
Ana de Santiago-Ruiz ◽  
Alcira Emperatriz Chávez-Lira ◽  
Oliver Mendoza-Cano ◽  
...  
Keyword(s):  
Palliative Care ◽  
Heart Disease ◽  
Liver Dysfunction ◽  
Symptom Control ◽  
Cross Sectional Study ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Cross Sectional ◽  
Accepted Practice ◽  
Sedative Drugs

Background Palliative sedation has been used to refer to the practice of providing symptom control through the administration of sedative drugs. The objective of this article was to characterise palliative sedation use in inpatients at a medium-stay palliative care unit. Material and methods A cross-sectional study was conducted on 125 randomly selected patients (aged 15 or older) who had died in 2014. The Palliative Performance Scale was used to evaluate the functional status. Results Palliative sedation was documented in 34.4% of the patients and midazolam was the most commonly used sedative agent (86.0%). More than half (53.5%) of those who recieved sedation presented with delirium. Liver dysfunction was more frequent in the sedated patients (p=0.033) and patients with heart disease were less likely (p=0.026) to be sedated. Conclusion Palliative sedation is an ethically accepted practice. It was commonly midazolam-induced, and differences were documented, among sedated and non-sedated patients, in terms of liver dysfunction and heart disease.

On the palliative care unit.

2016 ◽  
Vol 34 (2) ◽  
pp. 179-179
Author(s):  
Peter A. Selwyn
Keyword(s):  
Palliative Care ◽  
Palliative Care Unit
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