Chemotherapy Near the End of Life in Onco–Hematological Adult Patients

2020 ◽  
Vol 37 (8) ◽  
pp. 641-647
Author(s):  
Marina Sánchez-Cuervo ◽  
Lorena García-Basas ◽  
Esther Gómez de Salazar-López de Silanes ◽  
Cristina Pueyo-López ◽  
Teresa Bermejo-Vicedo
Keyword(s):  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Odds Ratio ◽  
Chemotherapy Regimen ◽  
Female Gender ◽  
Tertiary Hospital ◽  
Life Care ◽  
Oncological Patients ◽  
Scarce Data

Objective: The use of chemotherapy near the end of life is not advisable. There are scarce data in Europe but shows signs of aggressiveness. We designed this study to analyze the proportion of onco–hematological patients receiving chemotherapy within their last 2 weeks of life as well as starting a new chemotherapy regimen in the 30 days prior to death. Methods: A retrospective observational study was conducted in a tertiary hospital. Adults who died of an onco-hematological neoplasia while hospitalized between April 2017 and March 2018 were included. We assessed the use of chemotherapy over the course of the last 14 days of life, defined as the administration of at least one dose of chemotherapy. We also examined the proportion of patients starting a new chemotherapy regimen in the last 30 days of life. Results: A total of 298 inpatients died in the Hematology and Oncology units. During the last 14 days, 28.2% (n = 11) of hematological and 26.3% (n = 68) of oncological patients received chemotherapy; the overall rate was 26.5% (n = 79). Furthermore, the proportion of patients starting a new chemotherapy regimen in the last 30 days of life was high (20.5% and 20.8%, respectively). Female gender (odds ratio [OR] = 1.99, 95% confidence interval [CI] = 1.18-3.35) and age <45 (OR = 2.68, 95% CI = 1.05-6.88) were associated with higher rates of chemotherapy. Conclusion: The proportion of patients receiving chemotherapy in the last 14 days of life was high, as well as the proportion of patients starting a new regimen in their last 30 days. This was indicative of excessive aggressiveness at the end-of-life care.

scholarly journals End‐of‐life care in an Australian acute hospital: a retrospective observational study

2019 ◽  
Vol 49 (11) ◽  
pp. 1400-1405 ◽  
Author(s):  
Ninya Maubach ◽  
Monique Batten ◽  
Scott Jones ◽  
Judy Chen ◽  
Brett Scholz ◽  
...  
Keyword(s):  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Acute Hospital ◽  
Retrospective Observational Study ◽  
Life Care

‘Death rounds to support critical care nurses: a qualitative study’

2020 ◽  
pp. bmjspcare-2020-002533
Author(s):  
Keh Kiong Ong ◽  
Chew Lai Sum ◽  
Xuelian Jamie Zhou ◽  
Yeow Leng Chow
Keyword(s):  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychological Impact ◽  
Structured Interview ◽  
Tertiary Hospital ◽  
Critical Care Nurses ◽  
Life Care ◽  
One To One ◽  
Nurses Perceptions

ObjectiveProviding end-of-life care has a significant psychological impact on critical care nurses. Little is known about whether critical care nurses find death rounds useful as a support system. This study aimed to describe critical care nurses’ perceptions of attending death rounds.MethodsThis study was conducted using a qualitative descriptive design, using one-to-one audio-recorded interviews. The study was conducted at a 20-bed medical intensive care unit in a 1200-bed public tertiary hospital in Singapore. One-to-one interviews were conducted with 14 nurses using a semi-structured interview guide. Data was analysed using thematic analysis.ResultsCritical care nurses valued attending death rounds. They found death rounds to be an outlet to express themselves and remember patients, to draw and give peer support, to build nursing and interprofessional cohesiveness and to learn to improve palliative care. The death rounds were optimal when they felt safe to share, when there was a good facilitator, when the hierarchy was flat and when the audience was interdisciplinary. The barriers to a successful death round were the rounds being too formal, timing and not knowing the patients.ConclusionDeath rounds are a viable way to support critical care nurses in providing end-of-life care.

scholarly journals Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study

2020 ◽  
pp. bmjspcare-2020-002302
Author(s):  
Manon S Boddaert ◽  
Chantal Pereira ◽  
Jeroen Adema ◽  
Kris C P Vissers ◽  
Yvette M van der Linden ◽  
...  
Keyword(s):  
Palliative Care ◽  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Population Based ◽  
Exposure Group ◽  
Life Care ◽  
Patients With Cancer ◽  
Timely Access ◽  
The Impact

ObjectivesTo evaluate the impact of provision and timing of palliative care (PC) on potentially inappropriate end-of-life care to patients with cancer in a mixed generalist—specialist PC model.MethodA retrospective population-based observational study using a national administrative health insurance database. All 43 067 adults in the Netherlands, who were diagnosed with or treated for cancer during the year preceding their death in 2017, were included. Main exposure was either generalist or specialist PC initiated >30 days before death (n=16 967). Outcomes were measured over the last 30 days of life, using quality indicators for potentially inappropriate end-of-life care.ResultsIn total, 14 504 patients (34%) experienced potentially inappropriate end-of-life care; 2732 were provided with PC >30 days before death (exposure group) and 11 772 received no PC or ≤30 days before death (non-exposure group) (16% vs 45%, p<0.001). Most patients received generalist PC (88%). Patients provided with PC >30 days before death were 5 times less likely to experience potentially inappropriate end-of-life care (adjusted OR (AOR) 0.20; (95% CI 0.15 to 0.26)) than those with no PC or PC in the last 30 days. Both early (>90 days) and late (>30 and≤90 days) PC initiation had lower odds for potentially inappropriate end-of-life care (AOR 0.23 and 0.19, respectively).ConclusionTimely access to PC in a mixed generalist—specialist PC model significantly decreases the likelihood of potentially inappropriate end-of-life care for patients with cancer. Generalist PC can play a substantial role.

Aggressive End-of-Life Care and Symptom Relief Treatments in Terminally Ill Patients Who Had Discussed Withdrawal of Mechanical Ventilation: A Hospital-Based Observational Study

2020 ◽  
Vol 37 (11) ◽  
pp. 897-903
Author(s):  
Hsiao-Ting Chang ◽  
Ming-Hwai Lin ◽  
Chun-Ku Chen ◽  
Tzeng-Ji Chen ◽  
Shinn-Jang Hwang
Keyword(s):  
Mechanical Ventilation ◽  
Observational Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Relief ◽  
Terminally Ill ◽  
Shared Care ◽  
Life Care ◽  
Terminally Ill Patients ◽  
The Status

Objective: The aim of this study was to explore the status of aggressive end-of-life care and symptom relief treatments in terminally ill patients who had discussed the withdrawal of mechanical ventilation. Methods: This research is a retrospective observational study based on a chart review. Terminal patients aged ≥20 years, who were intubated with mechanical ventilation support, who underwent hospice-shared care, and who personally, or whose close relatives, had discussed the withdrawal of mechanical ventilation with hospice-shared care team members in a tertiary hospital in Taiwan during 2012 to 2015 were included. Demographics, medical conditions, and aggressive end-of-life care, including hospitalization, use of vasopressors, artificial nutrition, tube feeding, antibiotics, and symptom relief treatments including the use of opioids, steroids, and sedatives, were identified. The modes of care and treatments of patients by the status of withdrawal of mechanical ventilation were compared. Results: A total of 141 patients had discussed the withdrawal of mechanical ventilation, and 111 (78.7%) had been withdrawn. Aggressive end-of-life care was noted in all patients regardless of mechanical ventilation status. There were no significant differences in the number and pattern of aggressive end-of-life care measures between patients who had or had not been withdrawn. There were significantly higher rates of symptom relief treatments used in patients who had been withdrawn. Conclusions: Aggressive end-of-life care is common for patients who have discussed the withdrawal of mechanical ventilation. There are significantly higher rates of symptom relief medications administered in patients who have been withdrawn from mechanical ventilation.

scholarly journals A retrospective study on end-of-life care in the emergency department of a tertiary hospital in Singapore

2020 ◽  
pp. 201010582096017
Author(s):  
Jia Ling Goh ◽  
Julia Li Yan Jaffar ◽  
Hanxing Xu ◽  
Vincent Wei Ming Lum
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Symptom Control ◽  
Tertiary Hospital ◽  
Patient Comfort ◽  
Life Care ◽  
Common Procedure ◽  
Care Plans

Introduction: The emergency department receives a whole breadth of patient types. Those who are imminently dying may attend the emergency department in the hours or days leading up to their demise, necessitating the initiation of end-of-life care in the emergency department. Aim: The aim of our study was to describe the characteristics and management of imminently dying patients who had presented to our emergency department to identify opportunities for improvement in the provision of end-of-life care in the emergency department. Methods: A retrospective study involving patients who died in the emergency department within 48 hours of registration presenting between 1 January 2018 and 31 December 2018 was carried out. Results: Out of 59 included patients, 91.5% had pre-existing medical conditions; 25.4% had end-stage organ failure of which renal and cardiac were most common. Only 15.3% had preferred care plans documented and among these, only a minority (33.3%) had undergone formal advance care planning. The most common presenting symptom among patients who died within 48 hours was dyspnoea (44.1%). The most common investigation done was capillary blood glucose (84.7%) and the most common procedure was an intravenous peripheral cannula insertion (84.7%). Antibiotics were given in 30.5% of the patients and fentanyl was administered in 20.3% for symptom control. Conclusion: The majority of patients presenting to the emergency department within hours or days of their demise had pre-existing chronic or terminal conditions but only a few had specified their preferences for end-of-life care. Investigations and procedures that do not affect patient comfort or outcomes should be minimised.

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