scholarly journals Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Per Fürst ◽  
Staffan Lundström ◽  
Pål Klepstad ◽  
Peter Strang
Keyword(s):  
Palliative Care ◽  
Adverse Effects ◽  
Pain Control ◽  
Performance Status ◽  
Infusion Pump ◽  
Eastern Cooperative Oncology Group ◽  
Moderate Increase ◽  
Subcutaneous Infusion ◽  
Dying Patients ◽  
Continuous Subcutaneous Infusion

Abstract Background Continuous subcutaneous infusion (CSCI) via ambulatory infusion pump (AIP) is a valuable method of pain control in palliative care. When using CSCI, low-dose methadone as add-on to other opioids might be an option in complex pain situations. This study aimed to investigate the effects, and adverse effects, of CSCI for pain control in dying patients, with particular interest in methadone use. Methods This was an observational cohort study. Imminently dying patients with pain, admitted to specialized palliative inpatient wards and introduced on CSCI, were monitored daily by staff for symptoms (Integrated Palliative Care Outcome Scale - IPOS), sedation (Richmond Agitation and Sedation Scale – RASS), performance status (Eastern Cooperative Oncology Group - ECOG) and delirium (Confusion Assessment Method - CAM). Results Ninety-three patients with a median survival of 4 days were included. Of the 47 patients who survived ≥3 days, the proportion of patients with severe/overwhelming pain decreased from 45 to 19% (p < 0.001) after starting CSCI, with only a moderate increase in morphine equivalent daily dose of opioids (MEDD). Alertness was marginally decreased (1 point on the 10-point RASS scale, p = 0.001), whereas performance status and prevalence of delirium, regardless of age, remained unchanged. Both patients with methadone as add-on (MET, n = 13) and patients with only other opioids (NMET, n = 34), improved in pain control (p < 0.05 and 0.001, respectively), despite that MET patients had higher pain scores at baseline (p < 0.05) and were on a higher MEDD (240 mg vs.133 mg). No serious adverse effects demanding treatment stop were reported. Conclusions CSCI via AIP is an effective way to reduce pain in dying patients without increased adverse effects. Add-on methadone may be beneficial in patients with severe complex pain.

scholarly journals Palliative Performance Scale: Polish validation in hospice setting - a prospective observational study

2020 ◽  
Author(s):  
Tomasz Dzierżanowski ◽  
Tomasz Gradalski ◽  
Michael Kozlowski
Keyword(s):  
Palliative Care ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Karnofsky Performance Score ◽  
Care Providers ◽  
Free Standing ◽  
Ecog Performance Status ◽  
Rehabilitation Outcomes ◽  
Ecog Ps ◽  
Performance Scale

Abstract Background: Measuring functional status in palliative care may help clinicians to assess a patient’s prognosis, recommend adequate therapy, avoid futile or aggressive medical care, consider hospice referral, and evaluate provided rehabilitation outcomes. An optimized, widely used, and validated tool is preferable. The Palliative Performance Scale Version 2 (PPSv2) is currently one of the most commonly used performance scales in palliative settings. The aim of this study is the translation and validation process of a Polish translation of this tool (PPSv2-Polish). Methods: Two hundred patients consecutively admitted to a free-standing hospice were evaluated twice during 2 consecutive days for test-retest reliability. In the first evaluation, two different care providers independently evaluated the same patient to establish inter-rater reliability values. PPS-Polish was compared with the Karnofsky Performance Score (KPS), Eastern Cooperative Oncology Group (ECOG) Performance Status (ECOG PS), and Barthel Activities of Daily Living (ADL) Index to determine its construct validity. Results: A high level of full agreement between test and retest was seen (63%), and a good intra-class correlation coefficient of 0.85 (P<0.0001) was achieved. Excellent agreement between raters was observed when using PPSv2-Polish (Cohen’s kappa 0.91; P<0.0001). Satisfactory correlations with the KPS and good correlations with ECOG PS and Barthel ADL were noticed. Persons who had shorter prognoses and were predominantly bedridden also had lower scores measured by the PPSv2-Polish, KPS and Barthel ADL. A strong correlation of 0.77 between PPSv2-Polish scores and survival time was noted (P<0.0001). Moderate survival correlations were seen between KPS, ECOG PS, and Barthel ADL of 0.41; -0.62; and 0.58, respectively (P<0.0001). Conclusion: PPSv2-Polish is a valid and reliable tool measuring performance status in a hospice population and can be used in daily clinical practice in palliative care and research.

Preferred Place of Death for Patients With Incurable Cancer and Their Family Caregivers in Egypt

2018 ◽  
Vol 36 (5) ◽  
pp. 423-428
Author(s):  
Samy A. Alsirafy ◽  
Ahmad M. Hammad ◽  
Noha Y. Ibrahim ◽  
Dina E. Farag ◽  
Omar Zaki
Keyword(s):  
Palliative Care ◽  
Family Caregivers ◽  
Full Employment ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Place Of Death ◽  
Hospital Death ◽  
Incurable Cancer ◽  
Mediterranean Countries ◽  
Egyptian Patients

Background: Little is known about the place of death of patients with cancer in Eastern Mediterranean countries including Egypt, where palliative care is underdeveloped. Identifying the preferred place of death (PPoD) is important for the development of appropriate palliative care models in these countries. Objectives: To know the PPoD of Egyptian patients with incurable cancer and their family caregivers (FCGs) and to determine the factors that may impact their preferences. Methods: An observational cross-sectional study that included 301 dyads of patients with incurable cancer and one of their FCGs. A questionnaire was designed to collect data about the characteristics of patients and FCGs as well as their preferences. Results: The majority of dyads (272/301, 90.4%) answered the PPoD question. Home was the PPoD in 93% of patients and 90.1% of FCGs ( P = .218). The congruence between patients’ and FCGs’ PPoD was 92.7% (κ = 0.526). In multivariate analysis, poorer performance status (Eastern Cooperative Oncology Group 3 or 4) and full employment of FCGs associated significantly with patients’ preference to die in hospital (odds ratio [OR] = 3.015 [95% confidence interval [CI]: 1.004-9.054], P = .049 and OR = 4.402 [95% CI: 1.561-12.417], P = .005, respectively), while poorer performance status and nonreferral to the palliative medicine unit were associated with FCGs’ preference of hospital death (OR = 2.705 [95% CI: 1.105-6.626], P = .029 and OR = 2.537 [95% CI: 1.082-5.948], P = .032, respectively). Conclusions: The results of the current study suggest that home is the PPoD for the vast majority of Egyptian patients with incurable cancer and their FCGs. Palliative care interventions that promote home death of patients with incurable cancer are needed in Egypt.

scholarly journals Screening Patients With Cancer Admitted to Hanoi Medical University Hospital for Palliative Care Needs

2020 ◽  
pp. 1321-1327
Author(s):  
Quang V. Le ◽  
Huy L. Trinh ◽  
Kim Ngan T. Mai ◽  
Manh D. Pham ◽  
Paul A. Glare
Keyword(s):  
Palliative Care ◽  
Screening Tool ◽  
Performance Status ◽  
Locally Advanced ◽  
Eastern Cooperative Oncology Group ◽  
University Hospital ◽  
Care Needs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medical University

PURPOSE To evaluate a screening tool for identifying which patients admitted to the oncology ward of a Vietnamese hospital should be referred to specialist palliative care (PC). METHODS We performed a cross-sectional survey of consecutive patients hospitalized in the Department of Oncology and Palliative Care at Hanoi Medical University Hospital between June 2019 and September 2019. We translated a validated 11-item screening tool into Vietnamese and used a total score of ≥ 5 as a positive screen. RESULTS One hundred participants were recruited. Forty-four patients (44%) screened positive. Of these, 37 (84%) had locally advanced or metastatic disease, 31 (70%) had uncontrolled symptoms, and 43 (98%) requested a PC consultation. A score ≥ 5 was significantly more common in patients with stage IV disease versus earlier stage, performance status of Eastern Cooperative Oncology Group (ECOG) 2 versus ECOG 0, and when life-limiting complications of cancer were present. Screening identified four patients overlooked by oncologists as needing referral, and 34% of patients requesting a referral had scores < 5. CONCLUSION This screening tool provided oncologists with easy-to-use criteria for referring patients for PC. At the same time, it relieved the work load for under-resourced PC physicians by screening out requests with low-level need. This tool should be part of routine assessment on admission in all oncology units in Vietnam.

Continuous Subcutaneous Infusion of Buprenorphine for Cancer Pain Control

1989 ◽  
Vol 5 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Junko Noda ◽  
Shinichiro Umeda ◽  
Toshiyuki Arai ◽  
Akihiro Harima ◽  
Kenjiro Mori
Keyword(s):  
Cancer Pain ◽  
Pain Control ◽  
Subcutaneous Infusion ◽  
Continuous Subcutaneous Infusion

scholarly journals Risk Factors for Delirium in the Palliative Care Population: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Duan Guo ◽  
Taiping Lin ◽  
Chuanyao Deng ◽  
Yuxia Zheng ◽  
Langli Gao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Palliative Care ◽  
Group Performance ◽  
Meta Analysis ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Individual Risk ◽  
Case Control Studies

Objective: Delirium is common and highly distressing for the palliative care population. Until now, no study has systematically reviewed the risk factors of delirium in the palliative care population. Therefore, we performed a systematic review and meta-analysis to evaluate delirium risk factors among individuals receiving palliative care.Methods: We systematically searched PubMed, Medline, Embase, and Cochrane database to identify relevant observational studies from database inception to June 2021. The methodological quality of the eligible studies was assessed by the Newcastle Ottawa Scale. We estimated the pooled adjusted odds ratio (aOR) for individual risk factors using the inverse variance method.Results: Nine studies were included in the review (five prospective cohort studies, three retrospective case-control studies and one retrospective cross-section study). In pooled analyses, older age (aOR: 1.02, 95% CI: 1.01–1.04, I2 = 37%), male sex (aOR:1.80, 95% CI: 1.37–2.36, I2 = 7%), hypoxia (aOR: 0.87, 95% CI: 0.77–0.99, I2 = 0%), dehydration (aOR: 3.22, 95%CI: 1.75–5.94, I2 = 18%), cachexia (aOR:3.40, 95% CI: 1.69–6.85, I2 = 0%), opioid use (aOR: 2.49, 95%CI: 1.39–4.44, I2 = 0%), anticholinergic burden (aOR: 1.18, 95% CI: 1.07–1.30, I2 = 9%) and Eastern Cooperative Oncology Group Performance Status (aOR: 2.54, 95% CI: 1.56–4.14, I2 = 21%) were statistically significantly associated with delirium.Conclusion: The risk factors identified in our review can help to highlight the palliative care population at high risk of delirium. Appropriate strategies should be implemented to prevent delirium and improve the quality of palliative care services.

scholarly journals Validation of a palliative care outcome measurement tool supplemented by neurological symptoms (HOPE+): Identification of palliative concerns of neurological patients

2019 ◽  
Vol 33 (9) ◽  
pp. 1221-1231
Author(s):  
Kim Dillen ◽  
Markus Ebke ◽  
Andreas Koch ◽  
Ingrid Becker ◽  
Christoph Ostgathe ◽  
...  
Keyword(s):  
Palliative Care ◽  
Diagnostic Accuracy ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Outcome Measurement ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Measurement Tool ◽  
Operating Characteristics ◽  
Neurological Patients

Background: There is growing interest to integrate palliative care and its structures into the care of neurological patients. However, in Germany there is no comprehensive assessment tool capturing the symptoms of patients with advanced neurological diseases. Aim: To validate a newly developed palliative care measurement tool based on an extension of the validated core documentation system Hospice and Palliative Care Evaluation considering additional neurological issues (HOPE+). Design: Prospective, observational study using HOPE+ and as external criteria, the Eastern Cooperative Oncology Group (ECOG) performance status and the 12 months “surprise” question (12-SQ) in a neurological population, and assessment for its construct validity and diagnostic accuracy. Setting/participants: All newly admitted patients to the Department of Neurorehabilitation, Dr. Becker Rhein-Sieg-Clinic aged 18–100 years (#DRKS00010947). Results: Data from 263 patients (63 ± 14 years of age) were analyzed. HOPE+ revealed a moderately correlated six-factor structure ( r = –0.543–0.525). Correlation analysis to evaluate discriminant validity using ECOG as external criterion was high ( rs(261) = 0.724, p < 0.001) and confirmed for severely affected patients by adding the 12-SQ (“No”-group: 48.00 ± 14.92 vs “Yes”-group: 18.67 ± 7.57, p < 0.009). Operating characteristics show satisfactory diagnostic accuracy (area under the curve: 0.746 ± 0.049, 95% confidence interval = 0.650–0.842). Conclusion: HOPE+ demonstrates promising psychometric properties. It helps to assess palliative care issues of patients in neurological settings and, in combination with the 12-SQ, conceivably conditions when to initiate the palliative care approach in a population underrepresented in palliative care structures so far.

A Survey of Hospice and Palliative Care Physicians Regarding Palliative Sedation Practices

2016 ◽  
Vol 34 (3) ◽  
pp. 217-222 ◽  
Author(s):  
Michael R. Lux ◽  
Bridget McCrate Protus ◽  
Jason Kimbrel ◽  
Phyllis Grauer
Keyword(s):  
Palliative Care ◽  
Pain Control ◽  
The United States ◽  
Palliative Sedation ◽  
First Line ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Drug Of Choice ◽  
Dying Patients ◽  
Hospice And Palliative Care

Context: Patients nearing the end of life may experience symptoms that are refractory to standard therapeutic options. Physicians may consider palliative sedation to relieve intolerable suffering. There is limited clinical literature regarding preferred medications for palliative sedation. Objectives: To determine the preferred medications physicians use when implementing palliative sedation. Methods: An Internet-based, cross-sectional survey of hospice and palliative care physicians in the United States. Results: A link to the survey was e-mailed to 3130 physician members of the American Academy of Hospice and Palliative Medicine, of which 381 physicians completed the survey. Physicians were not required to answer all questions. Nearly all (n = 335, 99%) respondents indicated that palliative sedation may be used (acceptable by 73% [n = 248] for refractory symptoms and acceptable by 26% [n = 87] only for imminently dying patients). Seventy-nine percent (n = 252) believed that opioids should not be used to induce palliative sedation but should be continued to provide pain control. Midazolam was the most commonly selected first-line choice for palliative sedation (n = 155, 42%). The most commonly reported second-line agents for the induction of palliative sedation were lorazepam, midazolam (for those who did not select midazolam as first-line agent), and phenobarbital with a reported preference of 20% (n = 49), 19% (n = 46), and 17% (n = 40), respectively. Conclusion: Of the physicians surveyed, 99% (n = 335) felt that palliative sedation is a reasonable treatment modality. Midazolam was considered a drug of choice for inducing and maintaining sedation, and opioids were continued for pain control.

scholarly journals Impact of a Palliative Care Checklist on Clinical Documentation

2016 ◽  
Vol 12 (2) ◽  
pp. e241-e247 ◽  
Author(s):  
Maxine de la Cruz ◽  
Akhila Reddy ◽  
Marieberta Vidal ◽  
Kimberson Tanco ◽  
Ahsan Azhar ◽  
...  
Keyword(s):  
Palliative Care ◽  
Medical Records ◽  
Group Performance ◽  
Care Center ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Clinical Documentation ◽  
Edmonton Symptom Assessment Scale ◽  
Before And After ◽  
The Difference

Purpose: Checklists are used in many different settings for the purpose of standardization and reduction of preventable errors in practice. Our group sought to determine whether a palliative care checklist (PCC) would improve the clinical documentation of key patient information. Methods: An initial review of 110 randomly selected medical records dictated by 10 physicians was performed. The authors identified portions of the dictated medical records that were included regularly, as well as those that were frequently missed. A PCC was drafted after final approval was obtained from the 13 faculty members. Dictations from 13 clinical faculties in the supportive care center were reviewed. A χ2 test or Fisher’s exact test was applied to assess the difference in overall checked rates before and after checklist use. A paired t test was used to examine the difference in the average complete rate and checked rates before and after checklist use. Results: There were improvements in the documentation before and after the checklist for scores on the Cut-down, Annoyed, Guilty, Eye-opener questionnaire for alcoholism (79% v 94%; P ≤ .0001), psychosocial history (69% v 95%; P ≤ .0001), Eastern Cooperative Oncology Group performance status (38% v 81%; P ≤ .0001), advance care planning (28% v 41%; P = .0008), and overall (78% v 95%; P ≤ .0001). There was no significant improvement in the documentation for opioid-induced neurotoxicity (37% v 37%; P = .9492) or the Edmonton Symptom Assessment Scale (98% v 99%; P = .4511). Conclusion: Our study showed that the use of a PCC improved the quality of the documentation of a patient visit in an outpatient clinical setting.

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