Subcutaneous administration at home for symptom management in palliative care.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 49-49
Author(s):  
Luisa Fernanda Rodriguez ◽  
Cesar Antonio Consuegra Pareja ◽  
Alirio Bastidas ◽  
Marta Ximena Leon ◽  
Alejandra Umbacia ◽  
...  
Keyword(s):  
Palliative Care ◽  
Karnofsky Performance Status ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Oral Intake ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
The Mean ◽  
At Home

49 Background: Patients who require home-based palliative care have advanced complex illnesses with functional limitations and decline. Subcutaneous administration of drugs and hydration is a possible alternative when oral intake is hampered. This observational study characterized the use of subcutaneous catheters at a home based palliative care program in Bogotá, Colombia. Methods: Consecutive medical records from September 1, 2017 to February 28, 2018 were reviewed for 272 patients at a home based palliative care program who received subcutaneous administration of drugs and/ or hydration. Statistical analysis was performed to describe the characteristics of the population and its relation to the use of subcutaneous catheters using SPSS tool. Results: The mean age was 72 years (SD: 18), 163 (60%) were females, with a mean in Barthel Index 20 (SD:22), Karnofsky Performance Status Scale 36 (SD: 9.6), PPS of 36 (SD: 11), and PPI 6 (SD: 3.4). The mean time for subcutaneous use was of 34 days (SD: 52). The main indication for the subcutaneous route was poor symptom control in 162 (60%), and because of reduced oral intake in 107 (39%). The administration of drugs was done by a family member in 207 (76%), all trained by a nurse (spouse 14%, offspring 52%, others 34%). The mean number of drugs used per catheter was 3,7 (SD: 1,7). The most common opioid was hydromorphone (57%) followed by morphine (35%). Other medications used were haloperidol (59%) and midazolam (23%). The most common site of application was the upper right extremity. The change of the catheter due to dysfunction was made in 98 (36%) subjects, due to infection in 9 (3.3%) of the 272 patients and 1.5% of 594 catheter insertions. An association with catheter dysfunction was found after multivariate analysis of the time of catheter use and the number of medications. 240 patients (88.2%) died with the catheter in place. Conclusions: Subcutaneous administration of hydration and drugs when used with proper education, training, and followed up by home care programs is a useful strategy for delivering care at home for optimal symptom control for patients receiving palliative care.

scholarly journals Palliative care at home: Carers and medication management

2008 ◽  
Vol 6 (4) ◽  
pp. 349-356 ◽  
Author(s):  
Barbara A. Anderson ◽  
Debbie Kralik
Keyword(s):  
Palliative Care ◽  
Medication Management ◽  
Symptom Relief ◽  
Symptom Control ◽  
Subcutaneous Administration ◽  
Care Practice ◽  
Home Based ◽  
Palliative Care Setting ◽  
Care At Home ◽  
At Home

ABSTRACTObjective:The decision to receive palliative care at home brings with it the complexity of managing a medication regime. Effective symptom control is often directly linked to medication management and relies on access to medications at all times. In home-based palliative care practice, polypropylene syringes of medications may be drawn up and left in clients' domestic refrigerators for subcutaneous administration by carers to provide immediate relief for symptoms such as pain and nausea. However, although there has been some discussion in the literature about the need for ready access to medications for symptom control of clients receiving care in the community, the feasibility of this practice has received scant attention. The aim of this article is to present the carers' experiences of administering medications in this manner.Methods:Semistructured interviews with 14 carers, who were administering medication in a home-based palliative care setting, were analyzed using qualitative methods to develop meaning units and themes.Results:Interviews revealed that this practice was highly valued. The carers willingly assumed the responsibility of medication administration, as it allowed the clients to remain at home where they desired to be. They could provide immediate symptom relief, which was of utmost importance to both the client and carer. The carers were empowered in their caring role, being able to participate in the care provided, rather than standing on the sidelines as helpless observers. Carers acknowledged the security and ethical issues associated with the presence of certain medications in the home and valued the 24-h telephone support that was available to them. After clients had died, the carers reflected on their involvement in care and felt a sense of pride and achievement from administering medications in this way because they had been able to care for their loved ones at home and fulfill their wish to die there.Significance of results:These interviews confirm the feasibility of this practice, which is a component of quality end-of-life care.

Review of a Home-Based Palliative Care Program for Children with Malignant and Non-Malignant Diseases

1997 ◽  
Vol 13 (4) ◽  
pp. 28-33 ◽  
Author(s):  
Ernest A. Kopecky ◽  
Sheila Jacobson ◽  
Prashant Joshi ◽  
Maria Martin ◽  
Gideon Koren
Keyword(s):  
Palliative Care ◽  
Tertiary Care ◽  
Care Facility ◽  
Retrospective Chart Review ◽  
Care Program ◽  
Patient Characteristics ◽  
Palliative Care Program ◽  
Tertiary Care Facility ◽  
Home Based ◽  
At Home

This retrospective chart review presents the patient characteristics and utilization of the home-based palliative care program at The Hospital for Sick Children in Toronto. A total of 126 children dying from a broad spectrum of diseases was admitted during the period 1986–1994, referred from neurosurgery, genetic/metabolic, neurology, neonatology, nephrology, cardiology, general pediatrics, general surgery, and pulmonology. At the time of review, 15 patients remained alive and 18 had been discharged from the program. Mean age at the time of referral was 4.8 ± 0.51 years and mean age at death was 5.3 ± 0.55 years. The mean number of days in hospital was 26.5 ± 14.6 while days spent at home averaged 98.4 ± 15.2; thus 80% of the children's remaining time was spent at home. The average number of parent-team contacts was 3.5 ± 0.9 by pager and 24.0 ± 2.9 by telephone. Of the 93 patients who died in the program, 53% died at home, 18% died in community hospitals, and 29% died in a tertiary care facility. Analgesic medications were administered to 54% of the patients; 56% of these then required opioid analgesia for pain and symptom management. Home-based palliative care appeared to be an effective program for many children with a variety of terminal illnesses after adequate supports for the child and family had been established.

Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure

2017 ◽  
Vol 32 (2) ◽  
pp. 476-484 ◽  
Author(s):  
Frances Kam Yuet Wong ◽  
Ching So ◽  
Alina Yee Man Ng ◽  
Po-Tin Lam ◽  
Jeffrey Sheung Ching Ng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Transitional Home

Effectiveness of a Home-Based Palliative Care Program for End-of-Life

2003 ◽  
Vol 6 (5) ◽  
pp. 715-724 ◽  
Author(s):  
Richard D. Brumley ◽  
Susan Enguidanos ◽  
David A. Cherin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based

scholarly journals Effect of a Home‐Based Palliative Care Program on Healthcare Use and Costs

2016 ◽  
Vol 64 (11) ◽  
pp. 2288-2295 ◽  
Author(s):  
J. Brian Cassel ◽  
Kathleen M. Kerr ◽  
Donna K. McClish ◽  
Nevena Skoro ◽  
Suzanne Johnson ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Palliative Care Program ◽  
Healthcare Use ◽  
Home Based

scholarly journals Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12

2017 ◽  
Vol 53 (6) ◽  
pp. 1042-1049.e3 ◽  
Author(s):  
Pedro E. Pérez-Cruz ◽  
Oslando Padilla Pérez ◽  
Pilar Bonati ◽  
Oliva Thomsen Parisi ◽  
Laura Tupper Satt ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Program ◽  
Spanish Version ◽  
Palliative Care Program ◽  
Quality Of Dying ◽  
Home Based

Impact of the caregiver burden on the effectiveness of a home-based palliative care program: A mediation analysis

2019 ◽  
Vol 18 (3) ◽  
pp. 332-338 ◽  
Author(s):  
Angela J. Pereira-Morales ◽  
Luis Enrique Valencia ◽  
Luis Rojas
Keyword(s):  
Palliative Care ◽  
Caregiver Burden ◽  
Psychological Symptoms ◽  
Care Program ◽  
Palliative Care Program ◽  
Home Based ◽  
High Prevalence ◽  
The Relationship ◽  
Significant Mediator

AbstractObjectiveThe growing aging population and the high prevalence of several concomitant chronic diseases have contributed to the elevated rates of caregiver burden and suffering in patients. In turn, intending to relieve unnecessary pain in patients, there has been a rapid growth of outpatient palliative care programs. However, little has been studied about caregiver burden as a relevant factor potentially affecting the effectiveness of these programs. This study aimed to determine the extent of caregiver burden as a possible mediator on the effectiveness of a home-based palliative care program.MethodSixty-six palliative patients (56% women; mean age + SD = 71, 6 ± 17.7) and their caregivers were assessed with measures for physical, emotional, and psychological symptoms before and 1 month after the start of a home-based palliative care program.ResultsThe association between caregiver burden and palliative outcomes was corroborated with a categorical regression model (p < 0.01). Caregiver burden was found to be a significant mediator in the relationship between outcome measures for palliative care at baseline and after 1 month of enrollment in the program.Significance of resultsTo our knowledge, this is the first study to assess the role of caregiver burden in the effectiveness of a home-based palliative care program. Although further work is required, the results indicate that a patient-focused intervention does not have the same beneficial effect if the caregiver burden is not addressed. Future home-based palliative care programs should focus on caregivers as well as patients, with particular attention to psychosocial intervention on caregivers.

Is it possible for caregivers to administer subcutaneous hydration to patients with advanced cancer at home? Feasibility and perceptions.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 82-82
Author(s):  
Monica Grez ◽  
Pedro Perez-Cruz ◽  
Alfredo Rodriguez-Nunez ◽  
Francisca Villouta ◽  
Carolina Jaña ◽  
...  
Keyword(s):  
Palliative Care ◽  
Multivariate Analysis ◽  
Advanced Cancer ◽  
Prior Experience ◽  
Primary Caregivers ◽  
Care Program ◽  
Oral Route ◽  
Palliative Care Program ◽  
A Prospective Study ◽  
At Home

82 Background: Loss of oral route is common in patients with advanced cancer, particularly during end-of-life (EOL). EOL hydration may prevent the onset of symptoms associated with dehydration, mainly delirium, or decrease the severity of symptoms when they are present. Subcutaneous hydration (SCH) is the best way to hydrate the patients at home although it is infrequently used. Objectives: To evaluate the feasibility of receiving SCH at home administered by caregivers without previous experience and their subsequent perceptions. Methods: A prospective study of 52 patients with advanced cancer enrolled in a Home Palliative Care Program and their primary caregivers. Caregivers of patients were trained in SCH administration at home. Telephone controls were performed at 48 hours and at 7 days to assess adherence and complications. One month after the death, a survey to explore caregiver perceptions of SCH was performed. Results: Fifty-two patients were included, the median days with SCH were 12 (2-173) and 100% were able to maintain SCH for all the time indicated or until the patient died. The proportion of caregivers who reported that administering SCH had been easy or very easy were 35 (78%) and 26 (96%) at 48 hrs and at seven days, respectively. In the multivariate analysis, caregiver demographics were not associated with finding administration of SCH easy (Table 1). Adverse effects were mild and infrequent. Four weeks after the death, 98% (95% CI 0.88-0.99) of the caregivers reported that it was useful to have administered SCH to their relative.Conclusions: It is feasible to administer SCH to patients who are at home, by caregivers with no prior experience. Implement this technique at home will allow us to decrease the percentage of patients with dehydration at the EOL and to decrease the complications of being dehydrated. [Table: see text]

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service

2016 ◽  
Vol 34 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Katherine Pouliot ◽  
Carol S. Weisse ◽  
David S. Pratt ◽  
Philip DiSorbo
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Community Hospital ◽  
Hospital Admissions ◽  
Care Program ◽  
Emergency Department Visits ◽  
Care Providers ◽  
Palliative Care Program ◽  
Home Based ◽  
Visiting Nurse

Background: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. Aim: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine’s community hospital serving New York’s Capital District. Methods: This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Results: Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service. Conclusion: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients’ desire to remain at home and avoid hospital admissions.

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