Hot stone therapy in palliative care.

179 Background: Massage therapy is a popular adjunct to cancer palliation. Hot Stone therapy, a massage method with hot lava stones, is an ancestral native Indian medicine practice. Since 2011, funds permit us to offer Hot Stone therapy as a new Complementary Medicine for inpatients in the oncology unit where Palliative Care is integrated early into oncologic care. We assessed the effect of Hot Stone therapy in patients with advanced cancer on symptom severity. Methods: The study took place at Hopital prive Oceane, a private setting in France, between May 1, 2014 and May 1 , 2015. After physician's check, one nurse who has training in stone therapy method provided massage. We assessed - overall patient's satisfaction - severity of nine common symptoms with Edmonton Symptom Assessment System (ESAS) before and after the massage. We reported - number of each symptom (%) experienced by patient before the massage - number of massages (%) with change score for analyses. Results: Of 156 massages, 113 were assessed (82 patients). Satisfaction rate is 100%. Rate of symptoms before massages: pain, 51%; fatigue, 88%; nausea, 21%; depression, 63%; anxiety, 79%; drowsiness , 72%; lack of appetite, 62%;dyspnea, 36%; no wellbeing, 93%. Decrease of 2 points in change score: pain (71%), fatigue (22%), nausea (25%), depression (42%), anxiety (64%), drowsiness (10%), dyspnea (37%), wellbeing (84%). None increase except in drowsiness (41%) which can be explained by more relaxed patients. No difference in lack of appetite. Conclusions: In our experience, Hot Stone therapy is a type of massage that help patient feel better. A decrease in some very common symptom in palliative care was observed. Stone therapy is a safe method and can be use by training caregivers to alleviate a wide range of cancer symptoms or side effects of treatment with a non-pharmacological approach. Actually, we develop a Hot Stone therapy program's training to offer more massages in our institution.

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QOLP-18. A TIME-BASED MODEL OF EARLY PALLIATIVE CARE INTERVENTION IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA, A SINGLE INSTITUTION FEASIBILITY STUDY

Neuro-Oncology ◽

10.1093/neuonc/noz175.838 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi201-vi201 ◽

Cited By ~ 1

Author(s):

Margaret Johnson ◽

Luis Ramirez ◽

James Herndon ◽

Woody Massey ◽

Eric Lipp ◽

...

Keyword(s):

Palliative Care ◽

Healthcare Utilization ◽

Functional Assessment ◽

Symptom Assessment ◽

Assessment System ◽

Early Palliative Care ◽

Chronic Illness Therapy ◽

Before And After ◽

The Impact ◽

Historical Controls

Abstract OBJECTIVE There is no validated model for delivering palliative care (PC) in the glioblastoma (GBM) population. The primary objectives were to assess the feasibility and determine the acceptability of a time-based model of integrated specialty PC to patients and providers. Secondary objectives were to estimate the impact on healthcare utilization and quality of life (QoL) compared to historical controls. METHODS We consented and referred patients to PC at their initial Neuro-Oncology consultation between 4/2018 and 5/2019. We conducted QoL assessments (NCCN Distress Tool; Functional Assessment of Cancer Therapy-Brain (FACT-BR); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); Epworth Sleepiness Scale (ESS)) at (1) baseline (2) immediately after chemoradiation, and (3) 6 months following chemoradiation. Ongoing PC follow-up was at the discretion of the PC provider. We administered the Edmonton Symptom Assessment System (ESAS) before and after PC visits. We measured patient and referring provider satisfaction using FAMCARE-16 and a PC departmental survey, respectively. RESULTS We did not meet our goal enrollment of 50 patients. 32 were offered participation, 12 consented and 8 attended at least one PC visit. The mean number of PC visits was 1.6. Mean age was 62 (42–79). 75% had a KPS ≥80. Of those that did not complete the study, 2 died and 5 either withdrew consent or declined further visits. At baseline, 91.7 % had a NCCN distress score ≥4. Patients were overall satisfied with the intervention. CONCLUSION Introduction of specialty PC at the time of GBM diagnosis is challenging. Participants reported their experience as overall positive. Results from referring providers are pending. Due to low-enrollment we did not pursue further statistical comparisons regarding healthcare utilization compared to historical controls.

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Prescreening of Patient-reported Symptoms using the Edmonton Symptom Assessment System (ESAS) in Outpatient Palliative Cancer Care

10.21203/rs.2.16484/v1 ◽

2019 ◽

Author(s):

Garden Lee ◽

Han Sang Kim ◽

Si Won Lee ◽

Eun Hwa Kim ◽

Bori Lee ◽

...

Keyword(s):

Palliative Care ◽

Cancer Care ◽

Severe Symptom ◽

Symptom Burden ◽

Symptom Assessment ◽

Assessment System ◽

Advanced Cancer Patients ◽

Edmonton Symptom Assessment System ◽

Patient Reported

Abstract Background: Although early palliative care is associated with a better quality of life and improved outcomes in end-of-life cancer care, the criteria of palliative care referral are still elusive. Methods: We collected patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS) at the baseline, first, and second follow-up visit. The ESAS evaluates ten symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, dyspnea, sleep disorder, appetite, and wellbeing. A total of 71 patients were evaluable, with a median age of 65 years, male (62%), and the Eastern Cooperative Oncology Group (ECOG) performance status distribution of 1/2/3 (28%/39%/33%), respectively. Results: Twenty (28%) patients had moderate/severe symptom burden with the mean ESAS ≥5. Interestingly, most of the patients with moderate/severe symptom burdens (ESAS ≥5) had globally elevated symptom expression. While the mean ESAS score was maintained in patients with mild symptom burden (ESAS<5; 2.7 at the baseline; 3.4 at the first follow-up; 3.0 at the second follow-up; P =0.117), there was significant symptom improvement in patients with moderate/severe symptom burden (ESAS≥5; 6.5 at the baseline; 4.5 at the first follow-up; 3.6 at the second follow-up; P <0.001). Conclusions: Advanced cancer patients with ESAS ≥5 may benefit from outpatient palliative cancer care. Prescreening of patient-reported symptoms using ESAS can be useful for identifying unmet palliative care needs in advanced cancer patients.

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Assessing hope at the end of life: Validation of an experience of hope scale in advanced cancer patients

Palliative & Supportive Care ◽

10.1017/s1478951504040337 ◽

2004 ◽

Vol 2 (3) ◽

pp. 243-253 ◽

Cited By ~ 26

Author(s):

CHERYL L. NEKOLAICHUK ◽

EDUARDO BRUERA

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Assessment ◽

Well Being ◽

Assessment System ◽

Validity Evidence ◽

Advanced Cancer Patients ◽

Factor I ◽

Factor Ii

Objective:The purpose of this study was to gather validity evidence for an innovative experience of hope scale, theHope Differential-Short (HDS), and evaluate its clinical utility for assessing hope in advanced cancer patients.Methods:A consecutive sampling approach was used to recruit 96 patients from an inpatient tertiary palliative care unit and three hospice settings. Each participant completed an in-person survey interview, consisting of the following measures: HDS (nine items), Herth Hope Index (HHI), hope visual analog scale (Hope-VAS) and Edmonton Symptom Assessment System (ESAS).Results:Using factor analytic procedures, a two-factor structure for the HDS was identified, consisting ofauthentic spirit(Factor I) andcomfort(Factor II). The HDS factors had good overall internal consistency (α = 0.83), with Factor I (α = 0.83) being higher than Factor II (α = 0.69). The two factors positively correlated with the HHI, Hope-VAS, and one of the ESAS visual analog scales, well-being (range: 0.38 to 0.64) and negatively correlated with depression and anxiety, as measured by the ESAS (range: −0.25 to −0.42).Significance of results:This is the first validation study of the HDS in advanced cancer patients. Its promising psychometric properties and brief patient-oriented nature provide a solid initial foundation for its future use as a clinical assessment measure in oncology and palliative care. Additional studies are warranted to gather further validity evidence for the HDS before its routine use in clinical practice.

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Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System

Journal of Oncology Practice ◽

10.1200/jop.2016.019372 ◽

2017 ◽

Vol 13 (4) ◽

pp. e401-e407 ◽

Cited By ~ 6

Author(s):

Sherri L. Rauenzahn ◽

Susanne Schmidt ◽

Ifeoma O. Aduba ◽

Jessica T. Jones ◽

Nazneen Ali ◽

...

Keyword(s):

Palliative Care ◽

Standard Deviation ◽

Symptom Burden ◽

Symptom Assessment ◽

Cost Of Care ◽

Assessment System ◽

Referral System ◽

Referral Rates ◽

Ambulatory Oncology ◽

Edmonton Symptom Assessment Scale

Purpose: Research in palliative care demonstrates improvements in overall survival, quality of life, symptom management, and reductions in the cost of care. Despite the American Society of Clinical Oncology recommendation for early concurrent palliative care in patients with advanced cancer and high symptom burden, integrating palliative services is challenging. Our aims were to quantitatively describe the palliative referral rates and symptom burden in a South Texas cancer center and establish a palliative referral system by implementing the Edmonton Symptom Assessment Scale (ESAS). Methods: As part of our Plan-Do-Study-Act process, all staff received an educational overview of the ESAS tool and consultation ordering process. The ESAS form was then implemented across five ambulatory oncology clinics to assess symptom burden and changes therein longitudinally. Referral rates and symptom assessment scores were tracked as metrics for quality improvement. Results: On average, one patient per month was referred before implementation of the intervention compared with 10 patients per month after implementation across all clinics. In five sample clinics, 607 patients completed the initial assessment, and 430 follow-up forms were collected over 5 months, resulting in a total of 1,037 scores collected in REDCap. The mean ESAS score for initial patient visits was 20.0 (standard deviation, 18.1), and referred patients had an initial mean score of 39.0 (standard deviation, 19.0). Conclusion: This project highlights the low palliative care consultation rate, high symptom burden of oncology patients, and underuse of services by oncologists despite improvements with the introduction of a symptom assessment form and referral system.

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Use of Standardized Assessment Tools to Improve the Effectiveness of Palliative Care Rounds

Journal of Palliative Care ◽

10.1177/0825859717740051 ◽

2017 ◽

Vol 32 (3-4) ◽

pp. 134-140 ◽

Cited By ~ 1

Author(s):

Donna Spaner ◽

Valerie B. Caraiscos ◽

Christina Muystra ◽

Margaret Lynn Furman ◽

Jodi Zaltz-Dubin ◽

...

Keyword(s):

Palliative Care ◽

Patient Care ◽

Symptom Assessment ◽

Assessment System ◽

Assessment Tools ◽

Direct Patient Care ◽

Optimal Care ◽

Goals Of Care ◽

Care Plans ◽

Palliative Care Setting

Background: Optimal care for patients in the palliative care setting requires effective clinical teamwork. Communication may be challenging for health-care workers from different disciplines. Daily rounds are one way for clinical teams to share information and develop care plans for patients. Objective: The objective of this initiative was to improve the structure and process of daily palliative care rounds by incorporating the use of standardized tools and improved documentation into the meeting. We chose a quality improvement (QI) approach to address this initiative. Our aims were to increase the use of assessment tools when discussing patient care in rounds and to improve the documentation and accessibility of important information in the health record, including goals of care. Methods: This QI initiative used a preintervention and postintervention comparison of the outcome measures of interest. The initiative was tested in a palliative care unit (PCU) over a 22-month period from April 2014 to January 2016. Participants were clinical staff in the PCU. Results: Data collected after the completion of several plan-do-study-act cycles showed increased use and incorporation of the Edmonton Symptom Assessment System and Palliative Performance Scale into patient care discussions as well as improvement in inclusion of goals of care into the patient plan of care. Conclusion: Our findings demonstrate that the effectiveness of daily palliative care rounds can be improved by incorporating the use of standard assessment tools and changes into the meeting structure to better focus and direct patient care discussions.

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Impact of Palliative Care Unit Admission on Symptom Control Evaluated by the Edmonton Symptom Assessment System

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2005.04.007 ◽

2005 ◽

Vol 30 (4) ◽

pp. 367-373 ◽

Cited By ~ 50

Author(s):

Caterina Modonesi ◽

Emanuela Scarpi ◽

Marco Maltoni ◽

Stefania Derni ◽

Laura Fabbri ◽

...

Keyword(s):

Palliative Care ◽

Symptom Control ◽

Symptom Assessment ◽

Assessment System ◽

Palliative Care Unit ◽

Edmonton Symptom Assessment System

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Quality of Life of Patients with Advanced Cancer in Palliative Therapy and in Palliative Care

Aquichan ◽

10.5294/aqui.2019.19.3.7 ◽

2019 ◽

Vol 19 (3) ◽

pp. 1-14

Author(s):

Leonel dos Santos Silva ◽

Bruna Eloise Lenhani ◽

Dabna Hellen Tomim ◽

Paulo Ricardo Bittencourt Guimarães ◽

Luciana Puchalski Kalinke

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Palliative Therapy ◽

Symptom Assessment ◽

Assessment System ◽

Life Questionnaire ◽

Edmonton Symptom Assessment System ◽

Quality Of Life Questionnaire ◽

Chronic Illness Therapy

Objective: To assess the quality of life of patients with advanced cancer in palliative therapy and in palliative care. Materials and Methods: Quantitative, observational, cross-sectional, and analytic study conducted in a teaching hospital in Paraná, Brazil, from January to June 2018, with 126 patients: 107 in palliative therapy; 19 in exclusive palliative care. The questionnaires for data collection were: Quality of Life Questionnaire-Core 15-Palliative, Functional Assessment of Chronic Illness Therapy-Palliative Care 14, and Edmonton Symptom Assessment System. The Spearman non-parametric coefficient test was used for the analysis. Results: The overall quality of life in palliative therapy and in palliative care was, respectively, 71.54/59.65; when correlating the total score of quality of life of the Quality of Life Questionnaire-Core 15-Palliative with the Functional Assessment of Chronic Illness Therapy-Palliative Care 14 (p = 0.001), and the Edmonton Symptom Assessment System (p = 0.001), significant difference of better quality of life was observed in the palliative therapy. Conclusion: Patients in palliative therapy have good overall quality of life, while the palliative care group reports regular quality of life. The symptoms were milder in the palliative therapy and more intense and with greater significance in palliative care; hence, knowing the compromise of quality of life will help professionals in planning interventions with transdisciplinary approach for patients and for their families.

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Palliative care consultation team: symptom relief in first 48 hours of hospitalization

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2019-0391 ◽

2020 ◽

Vol 73 (6) ◽

Author(s):

Magda Aparecida dos Santos Silva ◽

Marcio Augusto Diniz ◽

Ricardo Tavares de Carvalho ◽

Toshio Chiba ◽

Cibele Andrucioli de Mattos-Pimenta

Keyword(s):

Palliative Care ◽

Pain Relief ◽

Symptom Relief ◽

Symptom Assessment ◽

Assessment System ◽

Point Reduction ◽

Palliative Care Consultation ◽

Symptom Intensity ◽

Consultation Team ◽

Care Consultation

ABSTRACT Objective: To compare the relief of symptoms provided by palliative care consultation team (PCCT) compared to the traditional care team (TC), in patients with advanced cancer in the first 48 hours of hospitalization. Method: Allocated to PCCT Group and TC Group, this study assessed 290 patients according to the Edmonton Symptom Assessment System (ESAS) within the first 48 hours of hospitalization. The main outcome was a minimum 2-point reduction in symptom intensity. Results: At 48 hours, the PCCT Group had a 2-point reduction in the mean differences (p <0.001) in pain, nausea, dyspnea, and depression; and TC Group, on nausea and sleep impairment (p <0.001). Multiple Logistic Regression found for the PCCT Group a greater chance of pain relief (OR 2.34; CI 1.01-5.43; p = 0.049). Conclusion: There was superiority of the PCCT Group for pain relief, dyspnea and depression. There is a need for more studies that broaden the understanding of team modalities.

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Clinical Care Conditions and Needs of Palliative Care Patients from Five Italian Regions: Preliminary Data of the DEMETRA Project

Healthcare ◽

10.3390/healthcare8030221 ◽

2020 ◽

Vol 8 (3) ◽

pp. 221 ◽

Cited By ~ 1

Author(s):

Gianlorenzo Scaccabarozzi ◽

Emanuele Amodio ◽

Luca Riva ◽

Oscar Corli ◽

Marco Maltoni ◽

...

Keyword(s):

Palliative Care ◽

Clinical Care ◽

Symptom Assessment ◽

Assessment System ◽

Care Needs ◽

Italian Regions ◽

Palliative Care Units ◽

The Right ◽

Noninterventional Study ◽

Palliative Care Needs

In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients’ needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.

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The impact of routine Edmonton symptom assessment system use on receiving palliative care services: results of a population-based retrospective-matched cohort analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002220 ◽

2020 ◽

pp. bmjspcare-2020-002220

Author(s):

Lisa Barbera ◽

Rinku Sutradhar ◽

Craig C Earle ◽

Doris Howell ◽

Nicole Mittman ◽

...

Keyword(s):

Palliative Care ◽

Cohort Analysis ◽

Symptom Assessment ◽

Assessment System ◽

Matched Cohort ◽

Edmonton Symptom Assessment System ◽

Care Services ◽

Patient Reported ◽

Palliative Care Services ◽

The Impact

BackgroundIn 2007, Cancer Care Ontario began standardised symptom assessment as part of routine care using the Edmonton Symptom Assessment System (ESAS).AimThe purpose of this study was to evaluate the impact of ESAS on receipt of palliative care when compared with a matched group of unexposed patients.DesignA retrospective-matched cohort study examined the impact of ESAS screening on initiation of palliative care services provided by physicians or homecare nurses. The study included adult patients diagnosed with cancer between 2007 and 2015. Exposure was defined as completing ≥1 ESAS during the study period. Using 4 hard and 14 propensity score-matched variables, patients with cancer exposed to ESAS were matched 1:1 to those who were not. Matched patients were followed from first ESAS until initiation of palliative care, death or end of study.ResultsThe final cohort consisted of 204 688 matched patients with no prior palliative care consult. The pairs were well matched. The cumulative incidence of receiving palliative care within the first 5 years was higher among those exposed to ESAS compared with those who were not (27.9% (95% CI: 27.5% to 28.2%) versus 27.9% (95% CI: 27.5% to 28.2%)), when death is considered as a competing event. In the adjusted cause-specific Cox proportional hazards model, ESAS assessment was associated with a 6% increase in palliative care services (HR: 1.06, 95% CI: 1.04 to 1.08).ConclusionWe have demonstrated that patients exposed to ESAS were more likely to receive palliative care services compared with patients who were not exposed. This observation provides real-world data of the impact of routine assessment with a patient-reported outcome.

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