Palliative Care Unit at Home: Impact on Quality of Life in Cancer Patients at the End of Life in a Rural Environment

2021 ◽  
pp. 104990912110383
Author(s):  
Maria Elena Iriarte Moncho ◽  
Vicente Palomar-Abril ◽  
Teresa Soria-Comes
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Cox Regression ◽  
Medical Department ◽  
The Impact ◽  
At Home

Introduction: Advanced cancer is accompanied by a substantial burden of symptoms, and palliative care (PC) plays an essential role, especially at the end of life (EOL). In fact, a comprehensive PC through Home Palliative Care Units (HPCU) has been associated with reducing potentially aggressive care at the EOL. We aim to study the impact of HPCU on the quality of assistance of cancer patients at Alcoy Health Department. Methods: A retrospective study was conducted including patients diagnosed with terminal cancer at the Medical Department of Hospital Virgen de los Lirios who died between January 2017 and December 2018. The Multivariate Cox regression model was used to assess the impact of HPCU assistance on the quality of life indicators. Results: 388 patients were included. The median age was 71 years; 65% patients were male, and 68% presented with a 0-2 score on the ECOG scale. On the multivariate analysis, a lack of assistance by HPCU was associated with a higher risk of consulting in the emergency department (OR = 1.29, 95% CI: 1.02-1.67), of hospital admissions (OR = 4.72, 95% CI: 2.45-9.09), a higher probability of continuing active treatment (OR = 2.59, 95% CI: 1.44-4.67), and a greater probability of dying in hospital (OR = 6.52, 95% CI: 3.78-11.27). Conclusions: Patients receiving HPCU assistance have a lower number of emergency room visits and hospital admissions, and are more likely to die at home. Taken together, these results support the relevance of HPCU providing a high quality attention of cancer patients.

Proactive, multidisciplinary approach to supportive medicine: Improving health outcomes and care utilization.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6537-6537
Author(s):  
Brooke Worster ◽  
Valerie P Csik ◽  
Jared Minetola ◽  
Gregory D. Garber ◽  
Alison Petok ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Hospital Admissions ◽  
Care Plan ◽  
Cancer Center ◽  
Care Plans ◽  
Oncology Care ◽  
The Impact

6537 Background: Evidence suggests that cancer patients who receive palliative care early in their disease have improved quality of life, decreased emergency department (ED) visits, and less aggressive end-of-life care. In 2017, the Sidney Kimmel Cancer Center at Jefferson established the Neu Center for Supportive Medicine and Cancer Survivorship (NCSMCS) as a model for integrated care in the outpatient setting for all cancer patients. A multidisciplinary team consisting of palliative care physicians, social work, psychology, and navigation conducts biopsychosocial screening and initiates a personalized care plan for each patient to clarify treatment goals and offer assistance. Objectives: To use biopsychosocial screening at specified time points to identify needs and evaluate the impact of supportive care as part of standardized oncology care regardless of stage. Methods: This assessment utilized Oncology Care Model (OCM) data for Jefferson Medicare patients between 7/1/16 to 7/31/18. Incidence of ED admits ED/Observation and admissions were evaluated as well as ICU utilization and advanced care planning. Poisson regression was used to generate incidence rate ratios (IRR) and 95% confidence intervals (CI) to facilitate the comparison of post- vs. pre- incidence rates of hospitalization. Results: The post-intervention hospital admissions decreased by 31% in NCSMCS (IRR 0.69; 95% CI 0.48-0.98) and by 10% in Non-NCSMCS (IRR 0.90; 0.84-0.96) and advanced care plans were more likely to be on file for NCSMCS (9.0% vs. 4.9%). The intensive care unit (ICU) admissions were decreased by 17% among Non-NCSMCS (IRR 0.83; 95% CI 0.74-0.93). The utilization rates for ED admissions were not statistically different among both the groups. Conclusions: The preliminary data is promising and impact will be monitored as the intervention is expanded. Reducing admissions has benefits from both a cost savings as well as quality of life perspective. Future analyses will consider the impact of the intervention on a patient’s quality of life.

scholarly journals Healing at the End of Life: The Voice of the Patient

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Cory Ingram
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Life Story ◽  
Patient Centered ◽  
Whole Person ◽  
Centered Care ◽  
The Impact

In palliative care we have the privilege to care for seriously ill people and their families. Some people value capturing their life story or illness journey on film. I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives. The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing. Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories. The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care. The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

scholarly journals Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

2021 ◽  
Author(s):  
Johanna Sommer ◽  
Christopher Chung ◽  
Dagmar M. Haller ◽  
Sophie Pautex
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Palliative Care ◽  
Pilot Study ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Communication Skills ◽  
Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

scholarly journals Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Elham Akhlaghi ◽  
Rebecca H. Lehto ◽  
Mohsen Torabikhah ◽  
Hamid Sharif Nia ◽  
Ahmad Taheri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Palliative Chemotherapy ◽  
Palliative Therapy ◽  
Related Quality ◽  
Health Related

Abstract Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

scholarly journals End-of-life Care Preferences among Cancer Patients in Southern Thailand: A University Hospital-based Cross-Sectional Survey

2021 ◽  
Author(s):  
Jarurin Pitanupong ◽  
Sahawit Janmanee
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
University Hospital ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
At Home

Abstract Background: End-of-life care preferences may be highly individual, heterogenic, and variable according to culture and belief. This study aimed to explore preferences and factors associated with end-of-life care among Thai cancer patients with the goal of helping optimize their quality of life.Methods: A cross-sectional study surveyed cancer outpatients at Songklanagarind Hospital from August to November 2020. The questionnaires inquired about: 1) personal and demographic information, 2) experiences with end-of-life care received by relatives, and 3) end-of-life care preferences. To determine end-of life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results: The majority of the 96 cancer outpatients were female (65.6%), and the overall mean age was 55.8 ±11.6 years. More than half of them had an experience of observing someone die (68.8%), and they were predominantly satisfied with the care received by their relatives in passing away at home surrounded by family (47.0%) and being conscious until the time of death (68.2%). Most participants preferred receiving the full truth regarding their illness (99.0%), being free of uncomfortable symptoms (96.9%), having their loved ones around (93.8%), being mentally aware at the last hour (93.8%), and having the sense of being meaningful in life (92.7%). Their 3 most important end-of-life care wishes were receiving the full truth regarding their illness, disclosing the full truth regarding their illness to family members, and passing away at home. Conclusion: In order to optimize the quality of life of terminal patients, end-of-life care should ensure they receive the full truth regarding their illness, experience no distress symptoms, remain mentally aware at the last hour of life, feel meaningful in life, and pass away comfortably with loved ones around.

scholarly journals End-of-life care preferences among cancer patients in Southern Thailand: a university hospital-based cross-sectional survey

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jarurin Pitanupong ◽  
Sahawit Janmanee
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
University Hospital ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
At Home

Abstract Background End-of-life care preferences may be highly individual, heterogenic, and variable according to culture and belief. This study aimed to explore preferences and factors associated with end-of-life care among Thai cancer patients. Its findings could help optimize the quality of life of palliative cancer patients. Methods A cross-sectional study surveyed palliative cancer outpatients at Songklanagarind Hospital from August to November 2020. The questionnaires inquired about: (1) personal and demographic information, (2) experiences with end-of-life care for their relatives, and (3) end-of-life care preferences. To determine end-of life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results The majority of the 96 palliative cancer outpatients were female (65.6 %), and the overall mean age was 55.8 ± 11.6 years. More than half of them had an experience of observing someone die (68.8 %), and they were predominantly being conscious until the time of death (68.2 %). Most participants preferred receiving the full truth satisfied with the care their relatives had received in passing away at home surrounded by family (47.0 %) and regarding their illness (99.0 %), being free of uncomfortable symptoms (96.9 %), having their loved ones around (93.8 %), being mentally aware at the last hour (93.8 %), and having the sense of being meaningful in life (92.7 %). Their 3 most important end-of-life care wishes were receiving the full truth regarding their illness, disclosing the full truth regarding their illness to family members, and passing away at home. Conclusions In order to optimize the quality of life of palliative cancer patients, end-of-life care should ensure they receive the full truth regarding their illness, experience no distressing symptoms, remain mentally aware at the last hour of life, feel meaningful in life, and pass away comfortably with loved ones around.

Coping, psychopathology, and quality of life in cancer patients under palliative care

2014 ◽  
Vol 13 (3) ◽  
pp. 517-525 ◽  
Author(s):  
Daniela B. Sorato ◽  
Flávia L. Osório
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Palliative Care ◽  
Problem Solving ◽  
Coping Strategies ◽  
End Of Life ◽  
Cancer Patients ◽  
Palliative Treatment ◽  
Anxiety And Depression

AbstractObjective:To assess hopelessness, anxiety, depression, and quality of life in cancer patients undergoing palliative treatment by comparing their scores at the onset of treatment and one month later and by assessing possible correlations with coping strategies.Method:Participants included 85 patients of both genders (56.5% female) diagnosed with advanced cancer who did not have curative therapeutic options who were assessed with self-applied instruments (the Beck Hopelessness Scale, the European Organization for the Research and Treatment of Cancer Quality of Life Core Questionnaire–Cancer 30, the Hospital Anxiety and Depression Scale, and the Coping Strategies Inventory by Folkman and Lazarus) at two timepoints: first before their appointment with doctors and other professionals in their first visit to the palliative care outpatient clinic (PCOC) and then as soon as patients arrived at the PCOC for their first medical follow-up visit (approximately 30 days after the first appointment).Results:The scores for hopelessness, anxiety, and depression remained stable (p = 0.24). The results were the same for the quality-of-life (QoL) variables, except for the fatigue and pain scores, which decreased (p = 0.01), and social impairment, which increased (p = 0.03). Analysis of the correlations between the coping mechanisms used after the onset of palliative treatment showed that confronting coping, seeking social support, and positive reappraisal were inversely correlated with hopelessness. Seeking social support, planful problem solving, and positive reappraisal were inversely correlated with indicators of depression. In contrast, use of the escape–avoidance strategy and reduced use of the planful problem-solving strategy were associated with increased anxiety.Significance of results:The employment of problem-focused coping strategies exerted a positive impact on the end-of-life process and, above all, protected patients from the negative experiences associated with psychiatric symptoms, thus enabling them to look for alternative solutions for experiencing the end-of-life process in a more well-adjusted manner.

scholarly journals Overburden of the caregiver of cancer patients in palliative care

2020 ◽  
Vol 14 ◽  
Author(s):  
Rafael Augusto Paes Lima Rocha ◽  
Elisângela De Moraes Rocha ◽  
Marli Elisabete Machado ◽  
Andressa De Souza ◽  
Felipe Barreto Schuch
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cancer Patients ◽  
Caregiver Burden ◽  
Cross Sectional ◽  
Zarit Burden Interview ◽  
Calidad De Vida ◽  
Independent Association ◽  
The Impact

Objetivo: correlacionar o impacto da sobrecarga do cuidador na qualidade de vida do paciente oncológico em cuidados paliativos Método: trata-se de um estudo quantitativo, descritivo, observacional, transversal, com 50 pacientes oncológicos em cuidados paliativos e 50 cuidadores. Aplicou-se um questionário sociodemográfico para os cuidadores e familiares, a Escala Zarit Burden Interview, o Questionário EORT QLQ –C15-PAL, a Escala de Resiliência Adaptada de Wagnild & Young e a Escala de Pensamento Catastrófico da Dor, uso do Teste t, Correlação de Spearman, Correlação de Pearson e regressão linear. Utilizou-se o Programa SPSS, versão 20.0 para a análise dos dados. Resultados: informa-se que os domínios da qualidade de vida que mostraram associação independente com a sobrecarga do cuidador foram a fatiga, a falta de apetite, a constipação e o impacto global. Manteve-se associação independente pelo catastrofismo da dor do paciente com a sobrecarga do cuidador, não houve associação entre a resiliência do paciente e a sobrecarga do cuidador e 40% dos cuidadores apresentaram sobrecarga severa. Conclusão: nota-se que o aumento da sobrecarga do cuidador diminui a qualidade de vida do paciente oncológico em cuidados paliativos. Descritores: Sobrecarga de Cuidadores; Qualidade de Vida; Cuidados Paliativos; Oncologia; Dor do Câncer, Resiliência.AbstractObjective: to correlate the impact of caregiver burden on the quality of life of cancer patients in palliative care. Method: this is a quantitative, descriptive, observational, cross-sectional study with 50 cancer patients in palliative care and 50 caregivers. A sociodemographic questionnaire was applied for caregivers and family members, the Zarit Burden Interview Scale, the EORT QLQ –C15-PAL Questionnaire, the Wagnild & Young Adapted Resilience Scale and the Catastrophic Pain Thinking Scale, using the t Test, Spearman's correlation, Pearson's correlation and linear regression. The SPSS program, version 20.0, was used for data analysis. Results: it is reported that the domains of quality of life that showed an independent association with caregiver burden were fatigue, lack of appetite, constipation and the global impact. An independent association was maintained due to the catastrophism of the patient's pain with the burden of the caregiver, there was no association between the patient's resilience and the burden of the caregiver and 40% of the caregivers presented severe burden. Conclusion: it is noted that the increase in caregiver burden reduces the quality of life of cancer patients in palliative care. Descriptors: Caregivers Burden; Quality of Life; Palliative Care; Oncology; Cancer Pain; Resiliencia.ResumenObjetivo: correlacionar el impacto de la carga del cuidador en la calidad de vida de los pacientes oncológicos en cuidados paliativos Método: este es un estudio cuantitativo, descriptivo, observacional, transversal con 50 pacientes oncológicos en cuidados paliativos y 50 cuidadores. Se aplicó un cuestionario sociodemográfico para cuidadores y miembros de la familia, la Escala Zarit Burden Interview, el Cuestionario EORT QLQ-C15-PAL, la Escala de Resiliencia Adaptada Wagnild& Young y la Escala de Pensamiento de Dolor Catastrófico, usando la Prueba t, Correlación de Spearman, la Correlación de Pearson y regresión lineal. El programa SPSS, versión 20.0, se utilizó para el análisis de datos. Resultados: se informa que los dominios de calidad de vida que mostraron una asociación independiente con la carga del cuidador fueron fatiga, falta de apetito, estreñimiento y el impacto global. Se mantuvo una asociación independiente debido al catastrofismo del dolor del paciente con la sobrecarga del cuidador, no hubo asociación entre la resistencia del paciente y la sobrecarga del cuidador y el 40% de los cuidadores presentaron una sobrecarga severa. Conclusión: se observa que el aumento de la sobrecarga del cuidador reduce la calidad de vida de los pacientes oncológicos en cuidados paliativos. Descriptores: Carga del Cuidador; Calidad de Vida; Cuidados Paliativos; Oncología; Dolor de Cáncer, Resiliencia.

scholarly journals Personality matters: relationship between personality characteristics, spirituality, demoralization, and perceived quality of life in a sample of end-of-life cancer patients

2021 ◽  
Author(s):  
Ada Ghiggia ◽  
Vanni Pierotti ◽  
Valentina Tesio ◽  
Andrea Bovero
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Cancer Patients ◽  
Functional Assessment ◽  
Protective Factor ◽  
Negative Relationship ◽  
Well Being ◽  
Demoralization Scale ◽  
The Impact

Abstract Purpose Personality could be an interesting dimension to explore in end-of-life cancer patients, in order to investigate how personality affects quality of life. Thus, this study aimed to investigate the relationship among personality through the Big Five Inventory (BFI), spirituality, and demoralization and to explore their impact on their quality of life. Methods A sample of 210 end-of-life Italian cancer patients were assessed with the BFI, the Demoralization Scale (DS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-SP-12), the Functional Assessment of Cancer Therapy Scale–General Measure (FACT-G), and the Karnofsky performance status. Results Correlational analysis highlighted a significantly negative relationship between extraversion and agreeableness traits and all the demoralization dimensions. On the other side, neuroticism trait was significantly and positively correlated with the Demoralization Scale (p < 0.01). To understand the impact of these variables on quality of life (FACT-G), we performed a hierarchical multiple regression: in the final model, demoralization remained the strongest contributing factor (β =  − 0.509, p < 0.001), followed by neuroticism (β =  − 0.175, p < 0.001), spirituality (β = 0.163, p = 0.015), and Karnofsky index (β = 0.115, p = 0.012). Conclusion Our data underlined how both the neuroticism trait and demoralization are correlated with a worst health status in terminal cancer patients, whereas spirituality is a protective factor. The study of personality may allow to better understand the inner patient’s experience and improve communication between patient and healthcare staff in order to build and apply better-tailored psychological treatment.

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