Improving the Quality of End-of-Life Care in Pediatric Oncology Patients Through the Early Implementation of Palliative Care

2017 ◽  
Vol 34 (6) ◽  
pp. 374-380 ◽  
Author(s):  
Lauren Ranallo
Keyword(s):  
Palliative Care ◽  
Supportive Care ◽  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Terminal Phase ◽  
Clear Understanding ◽  
Life Care ◽  
Oncology Patients ◽  
Children With Cancer

Providing end-of-life care to children with cancer is most ideally achieved by initiating palliative care at the time of diagnosis, advocating for supportive care throughout the treatment trajectory, and implementing hospice care during the terminal phase. The guiding principles behind offering palliative care to pediatric oncology patients are the prioritization of providing holistic care and management of disease-based symptoms. Pediatric hematology-oncology nurses and clinicians have a unique responsibility to support the patient and family unit and foster a sense of hope, while also preparing the family for the prognosis and a challenging treatment trajectory that could result in the child’s death. In order to alleviate potential suffering the child may experience, there needs to be an emphasis on supportive care and symptom management. There are barriers to implementing palliative care for children with cancer, including the need to clarify the palliative care philosophy, parental acknowledgement and acceptance of a child’s disease and uncertain future, nursing awareness of services, perception of availability, and a shortage of research guidance. It is important for nurses and clinicians to have a clear understanding of the fundamentals of palliative and end-of-life care for pediatric oncology patients to receive the best care possible.

Palliative care in the intensive cardiac care unit

2015 ◽  
Author(s):  
Jayne Wood ◽  
Maureen Carruthers
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
World Health ◽  
Terminal Phase ◽  
Cardiac Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Cardiac Care Unit

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by recent national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.

The effect of a multidisciplinary palliative care initiative on end-of-life care in gynecologic oncology patients

2017 ◽  
Vol 145 ◽  
pp. 23
Author(s):  
M.M. Mullen ◽  
L.M. Divine ◽  
B. Porcelli ◽  
I. Wilkinson-Ryan ◽  
M. Dans ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Life Care ◽  
Oncology Patients

Integrating palliative care into end-of-life care for children with cancer

2016 ◽  
Vol 1 (4) ◽  
pp. 289-301
Author(s):  
Amanda L. Linz ◽  
Joanna A. Lyman ◽  
Melody J. Cunningham ◽  
Justin N. Baker
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Children With Cancer

ICU utilization among oncology patients at the end of life.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 118-118
Author(s):  
Jennifer Hong ◽  
Christine Kurian ◽  
Jared Minetola ◽  
Valerie Pracilio Csik ◽  
Adam Binder
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Academic Medical Center ◽  
Cancer Type ◽  
Life Care ◽  
Oncology Patients ◽  
Code Status ◽  
Care Plans

118 Background: Patients with advanced cancer have high rates of hospitalizations as a result of their oncologic care. Furthermore, these patients receive aggressive end of life care despite evidence that aggressive end of life care does not improves quality of life or outcomes for patients and is associated with worse bereavement adjustment for caregivers. The American Society of Clinical Oncology has endorsed several indicators of aggressive end of life care, but most striking is intensive care unit (ICU) admission within 30 days before death. Methods: Adult oncology patients who died within 30 days of hospitalization and/or admitted to the ICU from 10/2018-3/2019 at an academic medical center were evaluated. The cohort was identified using ICD-10 codes, EMR systems support, and manual chart review. Patient demographic data, cancer type, stage, line of therapy, code status, advanced care plan, prior admissions as well as other clinical characteristics were collected. Results: In total, 180 patients were included for analysis; 106 of which were admitted to the ICU. Of patients admitted to the ICU, 58 patients died (54.7%). Mean ECOG performance status was 1.24. Average number of admissions 3 and 6 months prior to death was 0.71 and 1.26. Thirty six percent of patients were on first or second-line chemotherapy. 41.37% of patients who died in the ICU had prolonged length of stay (>1 week). Only 34.48% were known to palliative care prior to admission and 12.06% of patients had advanced care plans in place at time of hospitalization. Palliative care was consulted on 32.75% of patients who died in the ICU. Ninety Three percent had their code status changed prior to death. Conclusions: Despite established recommendations to support otherwise, at our institution there continues to be high utilization of ICU care near the end of life. Previous admissions and ECOG status are poor predictors of death in this cohort. The majority of patients had relapsed and refractory disease. There was a low rate of advanced care planning or palliative care involvement prior to the patient’s hospitalization. Further interventions are underway to improve end of life planning in order to improve our quality of care.

The effect of a multidisciplinary palliative care initiative on end of life care in gynecologic oncology patients

2017 ◽  
Vol 147 (2) ◽  
pp. 460-464 ◽  
Author(s):  
Mary M. Mullen ◽  
Laura M. Divine ◽  
Bree P. Porcelli ◽  
Ivy Wilkinson-Ryan ◽  
Maria C. Dans ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Gynecologic Oncology ◽  
Life Care ◽  
Oncology Patients

scholarly journals End-of-life care in children and adolescents with cancer: perspectives from a French pediatric oncology care network

2021 ◽  
pp. 030089162110133
Author(s):  
Sophie Blais ◽  
Sarah Cohen-Gogo ◽  
Elodie Gouache ◽  
Lea Guerrini-Rousseau ◽  
Benoit Brethon ◽  
...  
Keyword(s):  
Palliative Care ◽  
Children And Adolescents ◽  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Hematologic Malignancies ◽  
Developed Countries ◽  
Median Number ◽  
Life Care ◽  
Do Not Resuscitate

Background: In developed countries, cancer remains the leading cause of pediatric death from illness after the neonatal period. Objective: To describe the end-of-life care characteristics of children and adolescents with solid tumors (ST) or hematologic malignancies (HM) who died from tumor progression in the Île-de-France area. Methods: This is a regional, multicentric, retrospective review of medical files of all children and adolescents with cancer who died over a 1-year period. Extensive data from the last 3 months of life were collected. Results: A total of 99 eligible patients died at a median age of 9.8 years (range, 0.3–24 years). The most frequent terminal symptoms were pain (n = 86), fatigue (n = 84), dyspnea (n = 49), and anorexia (n = 41). Median number of medications per patient was 8 (range, 3–18). Patients required administration of opioids (n = 91), oxygen (n = 36), and/or sedation (n = 61). Decision for palliative care was present in all medical records and do-not-resuscitate orders in 90/99 cases. Symptom prevalence was comparable between children and adolescents with ST and HM. A wish regarding the place of death had been expressed for 64 patients and could be respected in 42 cases. Death occurred in hospital for 75 patients. Conclusions: This study represents a large and informative cohort illustrating current pediatric palliative care approaches in pediatric oncology. End-of-life remains an active period of care requiring coordination of multiple care teams.

Assessing the Unique Experiences and Needs of Muslim Oncology Patients Receiving Palliative and End-of-Life Care: An Integrative Review

2018 ◽  
Vol 34 (1) ◽  
pp. 52-61 ◽  
Author(s):  
Carolina Gustafson ◽  
Mark Lazenby
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Delivery ◽  
Data Extraction ◽  
Integrative Review ◽  
Life Care ◽  
Oncology Patients ◽  
Care Models ◽  
Patient Care Delivery

The objective of this review was to detail the experiences of Muslim oncology patients receiving palliative and end-of-life care and identify where gaps in the providing of culturally aware care occur. We also sought to examine ways in which providers could be better educated on the needs of Muslim patients at the end-of-life and identify barriers Muslims faced when being treated with hospice and palliative care models developed for non-Muslim populations. We conducted a search in April 2018 in the National Library of Medicine and CINAHL databases using the search terms “palliative care,” “Muslim,” and “cancer.” Included were articles with focuses on adult Muslims with palliative and end-of-life care experiences. We then followed the PRISMA guidelines for an integrative review and used a data extraction matrix to identify 20 papers that met the inclusion criteria of the review. We identified four major themes patient experiences, patient care delivery suggestions, Muslim provider experiences, and definitions of death, present in all 20 papers of the review. Each of the included papers was categorized based on the dominant theme in the paper. This review ultimately found that the care provided to Muslim patients is subpar for the standard of culturally competent care and that the needs of Muslim patients at the end-of-life, as well as the needs of their families, are not being met. Moving forward further research on this topic is needed with a particular focus on examining the experiences of terminally ill Muslim patients receiving treatment in non-Muslim majority settings.

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