Acute care medical interventions in the palliative care unit versus inpatient hospice.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 88-88
Author(s):  
Marieberta Vidal
Keyword(s):  
Palliative Care ◽  
The United States ◽  
Palliative Care Unit ◽  
Advanced Cancer Patients ◽  
Optimal Care ◽  
Medical Interventions ◽  
Team Meetings ◽  
Care Specialist ◽  
Hospital Executives ◽  
Palliative Care Units

88 Background: In a survey of different cancer centers in the United States, only 23% reported having dedicated palliative care beds and hospital executives have reported not having further plans for expansion of their program. Barriers that are often cited include poor reimbursement for services, limited institutional support and resources. Patients admitted to an Acute Palliative care unit (APCU) benefit from the multidisciplinary approach that is evident in daily rounds, interdisciplinary team meetings, and family conferences. There could be occasionally misconceptions about the differences between inpatient hospice and an APCU. Even though the psychosocial component of palliative care is extremely important a significant amount of medical interventions also are necessary to provide patients and family with a sense of and optimal care during this time. Methods: A retrospective chart reviewed was performed in 100 consecutives patients admitted to the APCU and inpatient hospice prior to October 2013. From this data we identified the acute medical interventions ordered by the palliative Care specialist tduring the first 5 days of admission. Results: A total of 100 patients from the APCU and 100 patients from inpatient hospice were reviewed. In the APCU 100% of patients had iv fluids vs 7% in inpatient hospice. Antibiotics were given in 52% of APCU patients vs 2% in the inpatient hospice. Steroids were given in 48% of APCU patients vs 30% in inpatient hospices. (See Table). Conclusions: The APCU in comparison to inpatient hospices had higher rate of acute medical interventions with the most common been iv fluids, antibiotics, laboratory and radiologic diagnostic tests. This represent the importance of Acute Palliative Care Units in advanced cancer patients with complicated situations to achieve comfort when transitioning to EOL. [Table: see text]

Differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units: A multicenter prospective cohort study (EASED)

2021 ◽  
pp. 026921632198956
Author(s):  
Takahiro Higashibata ◽  
Takayuki Hisanaga ◽  
Shingo Hagiwara ◽  
Miho Shimokawa ◽  
Ritsuko Yabuki ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Urinary Catheterization ◽  
Urinary Catheters ◽  
Advanced Cancer Patients ◽  
Appropriate Use ◽  
Palliative Care Units ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort

Background: Studies on the appropriate use of urinary catheters for cancer patients at the end of life are limited. Aim: To clarify the differences among institutions in the prevalence of and indications for urinary catheterization of advanced cancer patients at palliative care units. Design: Pre-planned secondary analysis of a multicenter, prospective cohort study; East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED). Setting/participants: This study enrolled consecutive advanced cancer patients admitted to palliative care units between January and December 2017. The final study group comprised 1212 patients from 21 institutions throughout Japan. Results: Out of the 1212 patients, 380 (31.4%; 95% confidence interval, 28.7%–34.0%) underwent urinary catheterization during their palliative care unit stay, and the prevalence of urinary catheterization in patients who died at palliative care units by institution ranged from 0.0% to 55.4%. When the 21 participating institutions were equally divided into three groups according to the institutional prevalence of catheterization, patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation were more likely to be catheterized in institutions with a high prevalence of catheterization than in those with a low or moderate prevalence ( p < 0.008, p = 0.008, and p < 0.008, respectively). Conclusion: This study revealed that the institutional prevalence of urinary catheterization in advanced cancer patients at palliative care units widely varied. Further studies are needed to establish the appropriate use of urinary catheters, especially in patients with difficulty in moving safely, exhaustion on movement, and restlessness or agitation.

Association between burnout and cortisol secretion, perceived stress, and psychopathology in palliative care unit health professionals

2017 ◽  
Vol 16 (3) ◽  
pp. 286-297 ◽  
Author(s):  
José Carlos Fernández-Sánchez ◽  
José Manuel Pérez-Mármol ◽  
Antonia Blásquez ◽  
Ana María Santos-Ruiz ◽  
María Isabel Peralta-Ramírez
Keyword(s):  
Palliative Care ◽  
Perceived Stress ◽  
Health Professionals ◽  
Health Workers ◽  
Maslach Burnout Inventory ◽  
Palliative Care Unit ◽  
Burnout Syndrome ◽  
Cortisol Secretion ◽  
Palliative Care Units ◽  
Waking Up

ABSTRACTObjective:A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population.Method:A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory–Human Services Survey (MBI–HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL–90–R Symptoms Inventory.Results:There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI–HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15–30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it.Significance of results:A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.

Clinical signs of dying in cancer patients: A prospective longitudinal observational study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19528-e19528
Author(s):  
David Hui ◽  
Renata dos Santos ◽  
Kelly L. Kilgore ◽  
Thiago Buosi Silva ◽  
Gary B. Chisholm ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Clinical Signs ◽  
High Specificity ◽  
The United States ◽  
Cancer Center ◽  
Mandibular Movement ◽  
Advanced Cancer Patients ◽  
Palliative Care Units ◽  
Md Anderson ◽  
Prospective Longitudinal

e19528 Background: The fundamental process of dying has not been well characterized. We determined the frequency, onset, accuracy and likelihood ratio (LR) for various clinical signs in dying cancer patients. Methods: We systematically documented 100 signs/symptoms on consecutive advanced cancer patients admitted to palliative care units at MD Anderson Cancer Center (MDA) in the United States and Barretos Cancer Hospital (BCH) in Brazil every 12 hours from admission to death/discharge in 2010/2011. We analyzed the serial data from death backwards using generalized estimating equations for decedents, and calculated the accuracy and LRs for all patients. Results: 203/357 (MDA 52, BCH 151) patients died, and had the following characteristics: average age 58 (range 18-88), female 49%, Caucasian 76%, median admission length 6(Q1-Q3 4-9) days. The average palliative performance scale decreased from 50% to 20% (P<0.001). The frequency of pulselessness of radial artery (PRA), decreased urine output, respiration with mandibular movement (RMM), inability to close eye lids (EL), death rattle, vocal cord grunting, Cheyne Stokes and nasolabial drooping increased as death approached (P<0.001 for all), with high LR+ for impending death (Table 1). Presence of PRA, RMM and EL had a high specificity (100%), positive predictive value (99.4%) and LR+ (13) for death in 3 days. Conclusions: We identified highly specific cardiovascular, respiratory and neuromuscular signs associated with imminent death. [Table: see text]

scholarly journals Providing dignity therapy to patients with advanced cancer: a feasibility study within the setting of a hospital palliative care unit

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Francesca Nunziante ◽  
Silvia Tanzi ◽  
Sara Alquati ◽  
Cristina Autelitano ◽  
Enrica Bedeschi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Real Life ◽  
Hospital Setting ◽  
Palliative Care Unit ◽  
Evaluation Procedure ◽  
Advanced Cancer Patients ◽  
Dignity Therapy ◽  
Feedback Questionnaire

Abstract Background Dignity is a basic principle of palliative care and is intrinsic in the daily practice of professionals assisting individuals with incurable diseases. Dignity Therapy (DT) is a short-term intervention aimed at improving the sense of purpose, meaning and self-worth and at reducing the existential distress of patients facing advanced illness. Few studies have examined how DT works in countries of non-Anglo Saxon culture and in different real-life settings. Moreover, most studies do not provide detailed information on how DT is conducted, limiting a reliable assessment of DT protocol application and of its evaluation procedure. The aim of this study was to assess the feasibility and acceptability of a nurse-led DT intervention in advanced cancer patients receiving palliative care. Method This is a mixed-method study using before and after evaluation and semistructured interviews. Cancer patients referred to a hospital palliative care unit were recruited and provided with DT. The duration of sessions, and timeframes concerning each step of the study, were recorded, and descriptive statistical analyses were performed. The patients' dignity-related distress and feedback toward the intervention were assessed through the Patient Dignity Inventory and the Dignity Therapy Patient Feedback Questionnaire, respectively. Three nurses were interviewed on their experience in delivering the intervention, and the data were analyzed qualitatively. Results A total of 37/50 patients were enrolled (74.0%), of whom 28 (75.7%) completed the assessment. In 76.7% of cases, patients completed the intervention in the time limit scheduled in the study. No statistically significant reduction in the Patient Dignity Inventory scores was observed at the end of the intervention; most patients found DT to be helpful and satisfactory. Building opportunities for personal growth and providing holistic care emerged among the facilitators to DT implementation. Nurses also highlighted too great of a time commitment and a difficult collaboration with ward colleagues among the barriers. Conclusions Our findings strongly support the acceptability, but only partially support the feasibility, of nurse-led DT in advanced cancer patients in a hospital setting. Further research is needed on how to transfer the potential benefits of DT into clinical practice. Trial registration Retrospectively registered on ClinicalTrial.gov NCT04738305.

An oncopalliative expertise unit in a French comprehensive cancer center: Experience at one year.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24077-e24077
Author(s):  
Christine Mateus ◽  
Laurence Vigouret-Viant ◽  
Sabine Voisin ◽  
Sophie Laurent ◽  
Perrine Renard ◽  
...  
Keyword(s):  
Palliative Care ◽  
Average Length ◽  
Care Pathway ◽  
Specific Treatment ◽  
Palliative Care Unit ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Refractory Symptoms ◽  
One Year

e24077 Background: Anticipation of palliative care improves advanced cancer patients quality of life and may increase survival. It has also been associated with health costs reduction. However it is made difficult by societal taboos and reluctance of patients and caregivers to talk about therapeutic limitations and end of life. Methods: In a large French Comprehensive Cancer Center (CCC), the causes for both emergency consultations and medical hospitalizations have been analyzed, showing that repeated hospitalizations are more frequent when the level of care complexity increases and when the therapeutic project is unclear. Considering the European and international experiences of acute palliative care unit (APCU), we decided to create an APCU with reinforced onco-palliative expertise. This Onco-Palliative Expertise Unit (OPEU) main objective, besides treating refractory symptoms is to allow oncologists, palliative care specialists, pts and relatives to discuss together in order to redefine the therapeutic project. Results: One year after opening, this 10-bed unit has received 251 patients in 314 stays. 53% came directly from the home, 46% were already being followed by our palliative care team. After an average length of stay of 11.6 days, discharge was distributed between return home (41%), a palliative care unit (26%), death (22%) and other oncology units, or other hospitals (11%). At the opening, refractory symptoms were the most frequent reason for hospitalization (67% of stays). For the first 6 months period to the second one, discussing the therapeutic project increased from 23% to 34% of the hospitalization causes in the OPEU, showing the appropriation of this unit by the oncologists. A discussion about the project was carried out for almost all stays. On admission, specific cancer treatment was ongoing for 56% of stays. After assessment and multidisciplinary discussion, 49% of them decided to stop chemotherapy. Conversely, the start or resumption of treatment was recommended for 9% of stays without specific treatment on admission. The OPEU is a decompression chamber in the pt care pathway, which allows a multidisciplinary analysis of the pt’s condition on a single unit and leads to a quick and more appropriate therapeutic decision. Of the 251 pts hospitalized, only 19% were readmitted to hospital during the same one-year period, mainly for refractory symptoms. Conclusions: The creation of an OPEU in a CCC allows getting around the taboo of palliative care. It supports the dialogue between the oncologist and the pt, allows the pt to make the therapeutic project evolve toward a life project, avoiding costly unreasonable obstinacy.

Palliative Care and Spiritual Care of Persons with HIV and AIDS

2017 ◽  
Author(s):  
Anna L. Dickerman ◽  
Yesne Alici ◽  
William Breitbart ◽  
Harvey Max Chochinov
Keyword(s):  
Palliative Care ◽  
Spiritual Care ◽  
Cultural Sensitivity ◽  
Symptom Control ◽  
Physical Symptom ◽  
The United States ◽  
Hiv And Aids ◽  
Course Of Illness ◽  
Doctor Patient Communication ◽  
Medical Interventions

The meaning and role of palliative and spiritual care have evolved over the last decades, along with the dramatically changing clinical picture of AIDS. Although advances in antiretroviral therapy and medical interventions have allowed persons with HIV/AIDS and access to care to live longer and healthier lives, many persons in the United States and throughout the world continue to die of AIDS. There is an increased need for a comprehensive, multidisciplinary approach to care including psychosocial and family support. Curative, palliative, and spiritual care should be integrated, without dichotomizing curative and palliative approaches, in order to meet the challenges of AIDS throughout the course of illness. This chapter reviews basic concepts of palliative and spiritual care, as well as specific challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, demoralization, dignity, meaning, cultural sensitivity, doctor–patient communication, and psychiatric contributions to physical symptom control are reviewed.

scholarly journals Learning a palliative care approach during the COVID-19 pandemic: A case study in an Infectious Diseases Unit

2020 ◽  
Vol 34 (9) ◽  
pp. 1220-1227 ◽  
Author(s):  
S Tanzi ◽  
S Alquati ◽  
G Martucci ◽  
L De Panfilis
Keyword(s):  
Palliative Care ◽  
Infectious Diseases ◽  
Symptom Relief ◽  
Symptom Control ◽  
Palliative Care Unit ◽  
Delivery Of Care ◽  
Team Meetings ◽  
Palliative Care Teams ◽  
Using Data

Background: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. Aim: The aim of the study was to describe a palliative care unit’s consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. Design: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. Setting/participants: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. Results: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study. Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. Conclusion: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients’ use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.

A Retrospective Chart Review of Transfusion Practices in the Palliative Care Unit Setting

2018 ◽  
Vol 36 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Giovanna Sirianni ◽  
Giulia Perri ◽  
Jeannie Callum ◽  
Sandra Gardner ◽  
Anna Berall ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Palliative Care Unit ◽  
Assessment Tools ◽  
Palliative Care Units

Background: There remains limited data in the literature on the frequency, clinical utility and effectiveness of transfusions in palliative care, with no randomized controlled trials or clinical practice guidelines on this topic. There are no routinely accepted practices in place for the appropriate transfusion of blood products in this setting. Aim: The aim of this study was to retrospectively review all transfusions in the palliative care units of 2, tertiary care hospitals in Canada. The goals were to elucidate the frequency, indications, patient characteristics, and practices around this intervention. Design: Descriptive, retrospective chart review. Setting/Participants: The clinical charts of patients admitted to the palliative care unit and who obtained blood transfusions for the period of April 1, 2015, to March 31, 2017, were reviewed. All patients admitted who obtained a transfusion were included. There were no exclusion criteria. Results: Transfusions in the palliative care units were rare despite their availability (0.9% at Sunnybrook and 1.4% Baycrest) and were primarily given to patients with cancer. The main symptom issues identified for transfusion were fatigue and dyspnea. The majority of patients endorsed symptomatic benefit with minimal adverse reactions though pre- and post-transfusion assessment practices varied greatly between institutions. Conclusions: Transfusions in the palliative care units were infrequent, symptom targeted, and well tolerated, though the lack of standardized pre/post assessment tools limits any ability to draw conclusions about utility. Patients would benefit from additional research in this area and the development of clinical practice guidelines for transfusions in palliative care.

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