Effects of Parenteral Hydration in Terminally Ill Cancer Patients: A Preliminary Study

2005 ◽  
Vol 23 (10) ◽  
pp. 2366-2371 ◽  
Author(s):  
Eduardo Bruera ◽  
Raul Sala ◽  
Maria Antonieta Rico ◽  
Jairo Moyano ◽  
Carlos Centeno ◽  
...  
Keyword(s):  
Treatment Group ◽  
Cancer Patients ◽  
Symptom Control ◽  
Terminally Ill ◽  
Oral Intake ◽  
Well Being ◽  
Terminally Ill Cancer Patients ◽  
Patients With Cancer ◽  
To Receive

Purpose Most patients with cancer develop decreased oral intake and dehydration before death. This study aimed to determine the effect of parenteral hydration on overall symptom control in terminally ill cancer patients with dehydration. Patients and Methods Patients with clinical evidence of mild to moderate dehydration and a liquid oral intake less than 1,000 mL/day were randomly assigned to receive either parenteral hydration with 1,000 mL (treatment group) or placebo with 100 mL normal saline administered over 4 hours for 2 days. Patients were evaluated for target symptoms (hallucinations, myoclonus, fatigue, and sedation), global well-being, and overall benefit. Results Twenty-seven patients randomly assigned to the treatment group had improvement in 53 (73%) of their 73 target symptoms versus 33 (49%) of 67 target symptoms in the placebo group (n=22; P = .005). Fifteen (83%) of 18 and 15 (83%) of 18 patients had improved myoclonus and sedation after hydration versus eight (47%) of 17 and five (33%) of 15 patients after placebo (P = .035 and P = .005, respectively). There were no significant differences of improvement in hallucinations or fatigue between groups. When blinded to treatment, patients (17 [63%] of 77) and investigators (20 [74%] of 27) perceived hydration as effective compared with placebo in nine (41%) of 22 patients (P = .78) and 12 (54%) of 22 investigators (P = .15), respectively. The intensity of pain and swelling at the injection site were not significantly different between groups. Conclusion Parenteral hydration decreased symptoms of dehydration in terminally ill cancer patients who had decreased fluid intake. Hydration was well tolerated, and a placebo effect was observed. Studies with larger samples and a longer follow-up period are justified.

Spirituality and religion in terminally ill patients with cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19587-19587
Author(s):  
P. Heras ◽  
K. Kritikos ◽  
A. Georgopoulou ◽  
A. Hatzopoulos ◽  
N. Kritikos
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Negative Association ◽  
Terminally Ill Cancer Patients ◽  
Patients With Cancer ◽  
Spirituality And Religion ◽  
Spiritual Well Being ◽  
Strong Negative Association

19587 Background: The importance of spirituality and religion in coping with a terminal illness is becoming increasingly recognised. We aimed to assess the relation between spiritual well-being, religiosity, depression, and end-of-life despair in terminally-ill cancer patients. Methods: One hundred forty three terminally ill cancer patients with a life expectancy of less than 6 months were interviewed with a series of standardised instruments, including the FACIT Spiritual Well-Being Scale, a religiosity index similar to those used in previous research, the Hamilton depression rating scale, the Memorial Symptom Assessment Scale and the Duke-UNC Functional Social Support Questionnaire. Results: A strong negative association was observed between the FACIT Spiritual Well-Being scale and the HDRS, but no such relationship was found for religiosity. Similar patterns were observed for the FACIT subscales, finding a strong negative association between the meaning and peace subscale (which corresponds to the more existential aspects of spirituality) and HDRS scores, whereas a positive, albeit nonsignificant, association was observed for the faith subscale (which corresponds more closely to religiosity). Conclusions: These results suggest that the beneficial aspects of religion may be primarily those that relate to spiritual well-being rather than to religious practices per se. Spiritual well-being offers some protection against end-of-life despair in those for whom death is imminent. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among terminally ill patients with cancer. No significant financial relationships to disclose.

Verbalized desire for death or euthanasia in advanced cancer patients receiving palliative care

2014 ◽  
Vol 13 (2) ◽  
pp. 295-303 ◽  
Author(s):  
Ernest Güell ◽  
Adelaida Ramos ◽  
Tania Zertuche ◽  
Antonio Pascual
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Semistructured Interview ◽  
Advanced Cancer Patients ◽  
Terminally Ill Cancer Patients ◽  
Symptom Intensity ◽  
Edmonton Symptom Assessment Scale ◽  
Desire To Die

AbstractObjective:We aimed to address the prevalence of desire-to-die statements (DDSs) among terminally ill cancer patients in an acute palliative care unit. We also intended to compare the underlying differences between those patients who make desire-to-die comments (DDCs) and those who make desire-for-euthanasia comments (EUCs).Method:We conducted a one-year cross-sectional prospective study in all patients receiving palliative care who had made a DDC or EUC. At inclusion, we evaluated symptom intensity, anxiety and depression, and conducted a semistructured interview regarding the reasons for these comments.Results:Of the 701 patients attended to during the study period, 69 (9.8%; IC95% 7.7–12.3) made a DDS: 51 (7.3%) a DDC, and 18 (2.5%) an EUC. Using Edmonton Symptom Assessment Scale (ESAS) DDC group showed higher percentage of moderate-severe symptoms (ESAS > 4) for well-being (91 vs. 25%; p = 0.001), depression (67 vs. 25%; p = 0.055), and anxiety (52 vs. 13%; p = 0.060) than EUC group. EUC patients also considered themselves less spiritual (44 vs. 84%; p = 0.034). The single most common reason for a DDS was pain or physical suffering, though most of the reasons given were nonphysical.Significance of results:Almost 10% of the population receiving specific oncological palliative care made a DDC (7.3%) or EUC (2.5%). The worst well-being score was lower in the EUC group. The reasons for both a DDC and EUC were mainly nonphysical. We find that emotional and spiritual issues should be identified and effectively addressed when responding to a DDS in terminally ill cancer patients.

Attitudes of Terminally Ill Cancer Patients About Euthanasia and Assisted Suicide: Predominance of Psychosocial Determinants and Beliefs Over Symptom Distress and Subsequent Survival

2002 ◽  
Vol 20 (8) ◽  
pp. 2134-2141 ◽  
Author(s):  
Maria E. Suarez-Almazor ◽  
Catherine Newman ◽  
John Hanson ◽  
Eduardo Bruera
Keyword(s):  
Cancer Patients ◽  
Assisted Suicide ◽  
Religious Beliefs ◽  
Terminally Ill ◽  
Well Being ◽  
Shortness Of Breath ◽  
Terminally Ill Cancer Patients ◽  
Symptom Intensity ◽  
Loss Of Appetite ◽  
Symptomatic Distress

PURPOSE: Although euthanasia and physician-assisted suicide (PAS) are controversial issues, the views of those most affected, terminal patients, are seldom explored. Our objective was to assess whether the attitudes about euthanasia/PAS of terminally ill cancer patients were determined by their symptomatic distress. PATIENTS AND METHODS: We conducted a survey of 100 patients with terminal cancer. Statements related to the legalization of euthanasia/PAS were scored using Likert scales. We also asked patients how often they had considered ending their lives. Their responses were analyzed in relation to disease characteristics, including an assessment of symptomatic severity, sociodemographic features, general beliefs about the suffering of cancer patients, and survival. RESULTS: Most patients (69%) supported euthanasia or PAS for one or more situations. The association between these attitudes and symptoms was weak, consistent in univariate analysis only for shortness of breath. No significant associations were observed with pain, nausea, well-being, loss of appetite, depression, or subsequent survival. Agreement with euthanasia was significantly related to male sex, lack of religious beliefs, and general beliefs about the suffering of cancer patients and their families. In multivariate analysis, the only characteristics that remained statistically associated with support were the strength of religious beliefs and the perception that patients with cancer are a heavy burden on their families. Frequency of suicidal ideation was associated with poor well-being, depression, anxiety, and shortness of breath, but not with other somatic symptoms such as pain, nausea, and loss of appetite. CONCLUSION: Symptom intensity had limited impact on the attitudes about euthanasia of terminally ill cancer patients. Our findings suggest that patient views are primarily determined by psychosocial traits and beliefs, as opposed to disease severity or symptomatic distress.

A pilot study of transformation, attributed meanings to the illness, and spiritual well-being for terminally ill cancer patients

2008 ◽  
Vol 6 (4) ◽  
pp. 335-340 ◽  
Author(s):  
Michiyo Ando ◽  
Tatsuya Morita ◽  
Virginia Lee ◽  
Takuya Okamoto
Keyword(s):  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Clinical Psychologist ◽  
Semistructured Interview ◽  
Search For Meaning ◽  
Terminally Ill Cancer Patients ◽  
Spiritual Well Being ◽  
Positive Meaning ◽  
High Level

ABSTRACTObjective:The present study investigated what types of transformation terminally ill cancer patients experienced from diagnosis until the terminal stage, what meanings terminally ill cancer patients attributed to their illness, and whether or not those who attributed positive meaning to their illness achieved high levels of spiritual well-being as a preliminary study.Method:Ten terminally ill cancer patients in the hospice wards of two general hospitals participated. A clinical psychologist conducted a semistructured interview with the patients individually for about 60 min. Patients completed the FACIT-Sp and HADS before the interview and talked about the meanings of cancer experience. The contents of the interviews were analyzed qualitatively. Patients were separated into high and low levels of spiritual-well being by the median of FACIT-Sp scores.Results:Three types of transformation were extracted: “group with peaceful mind,” “group with both positive attitude and uneasy feeling,” and “groups with uneasy feeling.” As attributed meanings to the illness, five categories were extracted: “positive meaning,” “natural acceptance,” “negative acceptance,” “search for meaning,” and “regret and sorrow.” Patients in the high level spiritual well-being group attributed the meaning of illness to “positive meaning” and “natural acceptance,” and those in the low level spiritual well-being group attributed it to “regret and sorrow” and “search for meaning.”Significance of results:Some Japanese terminally ill cancer patients experienced positive transformation, and patients who attributed “positive meaning” and “natural acceptance” to their illness experience achieved high levels of spiritual well-being.

International comparison study on the primary concerns of terminally ill cancer patients in short-term life review interviews among Japanese, Koreans, and Americans

2009 ◽  
Vol 7 (3) ◽  
pp. 349-355 ◽  
Author(s):  
Michiyo Ando ◽  
Tatsuya Morita ◽  
Sung-Hee Ahn ◽  
Felicia Marquez-Wong ◽  
Saburo Ide
Keyword(s):  
Cancer Patients ◽  
Terminally Ill ◽  
Depression Scale ◽  
Well Being ◽  
The United States ◽  
Life Review ◽  
Short Term ◽  
Terminally Ill Cancer Patients ◽  
Interview Session ◽  
First Session

AbstractObjective:The aim of this study was to investigate the primary concerns of terminally ill cancer patients in a Short-Term Life Review among Japanese, Koreans, and Americans to develop intervention programs to be tailored to patients in other countries.Method:Twenty Japanese, 16 Korean, and 7 American terminally ill cancer patients who were in the hospice wards of general Christian hospitals in each country participated in this study. Medical staff members (nurses, social workers, clinical psychologists) performed Short-Term Life Review Interviews with each patient. Patients reviewed their lives in the first session, the interviewers made simple albums for each patient in the week following the first session, and patients and interviewers then confirmed the contents of the album. The treatment period was 1 week. Measurement instruments included the Functional Assessment Chronic Illness Therapy–Spiritual (FACIT-Sp) and the Hospital Anxiety and Depression Scale (HADS). The contents of each interview session were transcribed, and correspondence analysis and a significance test were conducted on these data to select characteristic words or phrases.Results:Using the FACIT-Sp scores, the following concerns were chosen, in descending order of frequency. In Japan, primary concerns consisted of such ideas as “good human relationships and transcendence,” “achievements and satisfaction,” “good memories and important things,” and “bitter memories.” In Korea, “religious life,” “right behavior for living,” “strong consideration for children and will,” and “life for living” were primary concerns. In the United States, “love, pride, will to children,” “good, sweet memories,” and “regret and a feeling of loss” were primary concerns.Significance of results:We clarify the differences among the primary concerns from the Short-Term Life Reviews, arguing that we can improve the spiritual well-being of terminally ill cancer patients by focusing on the primary concerns within each country.

Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients

The Lancet ◽  
2003 ◽  
Vol 361 (9369) ◽  
pp. 1603-1607 ◽  
Author(s):  
Colleen S McClain ◽  
Barry Rosenfeld ◽  
William Breitbart
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Terminally Ill Cancer Patients ◽  
Spiritual Well Being

The Family in Hospital-Based Home Care with Special Reference to Terminally Ill Cancer Patients

1993 ◽  
Vol 9 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Barbro Beck-Friis ◽  
Peter Strang
Keyword(s):  
Home Care ◽  
Cancer Patients ◽  
Symptom Control ◽  
Terminally Ill ◽  
Next Of Kin ◽  
Terminally Ill Cancer Patients ◽  
Terminally Ill Patients ◽  
Economic Support ◽  
The Family

Eighty-seven next of kin, 80 spouses and seven adult children, were the primary caregivers of terminally ill patients (87% cancer patients) cared for at the hospital-based home care (HBHC) unit of Motala Hospital during 1989–1990. All of the patients died in their homes. Next of kin were asked to complete self-questionnaires and to give written comments on their experiences and their perception of how the patient had felt about 13 aspects of home care provided by the HBHC staff. The response rate was 94%. In nine out of 13 areas, such as adequate information at the time of referral about the HBHC, security, support, immediate extra help when needed, high quality of nursing, and care and pain control, 86%–97% of next of kin were very satisfied (7–9 on a 9-point scale); whereas information provided about the disease, economic support, and support given after death were very satisfactory according to 72%, 58%, and 80% of relatives, respectively. Gender and time from diagnosis to death did not seem to affect responses. Next of kin of cancer patients were generally more satisfied than next of kin of other terminally ill patients. A total time of care of more than 60 days (median time) was associated with significantly more positive responses. Older spouses were significantly more satisfied with the HBHC than younger ones; despite this, 99% of all next of kin would choose HBHC again in a similar situation. It is concluded that very satisfactory terminal home care can be achieved, but it presupposes effective, prompt support and symptom control, 24 hours per day, and that both patient and family wish to participate in the HBHC.

Major Depression, Adjustment Disorders, and Post-Traumatic Stress Disorder in Terminally Ill Cancer Patients: Associated and Predictive Factors

2004 ◽  
Vol 22 (10) ◽  
pp. 1957-1965 ◽  
Author(s):  
Tatsuo Akechi ◽  
Toru Okuyama ◽  
Yuriko Sugawara ◽  
Tomohito Nakano ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Cancer Patients ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Terminally Ill ◽  
Anxiety And Depression ◽  
Post Traumatic Stress ◽  
Terminally Ill Cancer Patients ◽  
Post Traumatic

Purpose Few studies have been conducted to elucidate the psychological distress of terminally ill cancer patients. This study attempted to determine the prevalence of adjustment disorders (AD), major depression (MD), and post-traumatic stress disorder (PTSD) among terminally ill cancer patients, to identify factors that contribute to them, and to determine how they change longitudinally. Patients and Methods Consecutive terminally ill cancer patients were recruited. Patients were assessed for psychiatric disorders by structured clinical interview twice: once at the time of their registration with a palliative care unit (baseline), and again at the time of their palliative care unit admission (follow-up). Possible contributed biomedical and psychosocial factors were evaluated. Results The proportions of patients diagnosed with AD, MD, and PTSD at baseline (n = 209) were 16.3%, 6.7%, and 0% respectively, whereas at follow-up (n = 85), 10.6% were diagnosed with AD and 11.8% with MD. Lower performance status, concern about being a burden to others, and lower satisfaction with social support were significantly associated with AD/MD at baseline. There were changes in the diagnosis of AD and MD in 30.6% of the patients. Only the Hospital Anxiety and Depression Scale at the baseline was significantly predictive of AD/MD at follow-up. Conclusion The factors underlying psychological distress are multifactorial. Early intervention to treat subclinical anxiety and depression may prevent subsequent psychological distress.

Accurate prognostic awareness and preference states influence the concordance between terminally ill cancer patients’ states of preferred and received life-sustaining treatments in the last 6 months of life

2019 ◽  
Vol 33 (8) ◽  
pp. 1069-1079 ◽  
Author(s):  
Fur-Hsing Wen ◽  
Jen-Shi Chen ◽  
Wen-Cheng Chang ◽  
Wen-Chi Chou ◽  
Chia-Hsun Hsieh ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Nutritional Support ◽  
Terminally Ill ◽  
Cardiac Massage ◽  
Life Care ◽  
Terminally Ill Cancer Patients ◽  
Life Sustaining Treatment ◽  
To Receive

Background: Factors facilitating/hindering concordance between preferred and received life-sustaining treatments may be distorted if preferences and predictors are measured long before death. Aim: To examine factors facilitating/hindering concordance between cancer patients’ preferred and received life-sustaining-treatment states in their last 6 months. Design: Longitudinal, observational design. Setting/participants: States of preferred and received life-sustaining treatments (cardio-pulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, and nasogastric tube feeding) were examined in 218 Taiwanese cancer patients by a latent transition model with hidden Markov modeling. Multivariate logistic regression modeling was used to examine factors facilitating/hindering concordance between preferred and received life-sustaining-treatment states. Results: Concordance between preferred and received life-sustaining-treatment states was poor (40.8%, kappa value (95% confidence interval): 0.05 [–0.03, 0.14]). Patients who accurately understood their prognosis and preferred comfort care were significantly more likely to receive preferred life-sustaining treatments before death than those who did not know their prognosis but wanted to know, those who were uniformly uncertain about what life-sustaining treatments they preferred to receive, and those who preferred nutritional support but declined other life-sustaining treatments. Patient age, physician–patient end-of-life-care discussions, symptom distress, and functional dependence were not associated with concordance between preferred and received life-sustaining-treatment states. Conclusion: Prognostic awareness and preferred states of life-sustaining treatments were significantly associated with concordance between preferred and received life-sustaining-treatment states. Personalized interventions should be developed to cultivate terminally ill cancer patients’ accurate prognostic awareness, allowing them to formulate realistic life-sustaining-treatment preferences and facilitating their receiving value-concordant end-of-life care.

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