Improving access to timely pain management in an underserved oncology clinic: A palliative care-oncology partnership.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18672-e18672
Author(s):  
Aaron Chan ◽  
Radu Firtat ◽  
Christopher Metchnikoff ◽  
Phillis Wu ◽  
Katherine Yu
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Pain Score ◽  
Real Time ◽  
Cancer Patients ◽  
Pain Assessment ◽  
Medical Center ◽  
Safety Net ◽  
Therapeutic Interventions ◽  
Average Score

e18672 Background: In the 4 years since inception, the palliative care (PC) clinic at Olive-View UCLA Medical Center (OVMC) cared for less than 6% of pain-positive cancer patients based on guidelines put forth by ASCO. As with other under-resourced safety-net settings, the demand for PC services at OVMC far exceeds the manpower available for optimal pain management in oncology patients. This year long project aims to improve pain management in a busy oncology clinic via enhanced identification and prompt treatment of cancer pain by Oncologists. Methods: At the project start, Oncologists were surveyed to identify key elements to be incorporated into formal didactics on pain management principles, case-based discussions and real-time mentoring. At the weekly oncology clinic, patients were screened for pain using the multi-modal PEG scale: Average Pain intensity (P), interference with Enjoyment of life (E), and interference with General activity (G) over the preceding week. The Oncologist was notified of the PEG score if a patient had an average score ≥4 (0-10 scale) for review and intervention. Patients were screened using the same method at subsequent visits. EHR of patients with PEG scores ≥4 were reviewed to determine whether therapeutic interventions were made by the Oncologist. A comparison of PEG scores to the standard nursing intake pain scores was also conducted. Results: Over a 4-month period, 513 PEG forms were administered, 37% of which resulted in a pain score ≥4. Of the 172 patients who screened positive, 54 patients were screened at follow up visit(s). Comparing the pain-positive cohort, we observed an average decrease in pain by 25.5% (7.1 to 5.3) in patients who received intervention as opposed to 7.4% (5.0 to 4.7) in patients who did not receive intervention by their Oncologist. Further, there was a remarkable divergence between the average PEG score (6.7) and nurse intake pain score (1.4) in this patient cohort. Conclusions: Our findings suggest that improved Oncologist real-time pain assessment and intervention incorporating a validated pain screening tool leads to timely pain management in cancer patients. Implementation of a Palliative Care-Oncology partnership promotes provider awareness and confidence in treating patients with complex pain. A functional pain assessment, using PEG, can more accurately reflect pain compared to the current standard nursing intake process. Particularly in resource challenged settings where access to PC is limited, facilitating timely pain management through training and mentoring of oncologists or other primary providers can be a sustainable model to improve patient access to primary palliative care. Given the early indicators of success we hope to expand this workflow in training other healthcare providers within our County safety net system. Research Sponsor: California Health Care Foundation.

scholarly journals PALLIATIVE CARE

2018 ◽  
Vol 25 (12) ◽  
pp. 1910-1914
Author(s):  
Ramsha Nadeem ◽  
Samina Qamar ◽  
M. Abbas Khokhar ◽  
Maryam Abid ◽  
Remisha Zahid
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Cancer Patients ◽  
Pain Assessment ◽  
Pain Control ◽  
Rating Scale ◽  
Medical Oncology ◽  
Pain Scale ◽  
World Health ◽  
Advanced Malignancy

Pain is a devastating symptom of advanced cancers. Inadequate assessment and failure in following WHO (World health organization) guidelines for pain management are barriers to pain control in cancer patients. Objectives: To determine frequency of inadequate pain assessment leading to inadequate pain control in advanced stage cancer patients receiving palliative care. Subjects and Methods: 180 patients, within age 18 to 70 years of both genders, of cancer with stage 3 and 4 disease receiving palliative treatment for pain due to primary or metastatic disease requiring opioidanalgesics presenting to inpatient department of Medical Oncology, Mayo Hospital Lahore were selected using non probability, consecutive sampling. Study Design: Cross sectional descriptive study. Setting: Department of Medical Oncology, Mayo Hospital Lahore. Period: 6 months after approval of synopsis from 01.06.2017 to 01.01.2018. The Pain scales used were Numerical Rating Scale- NRS, followed by Visual Analogue Scale-VAS. All patients were evaluated whether or not their pain was assessed by a standard pain scale, the type of malignancy, and the stage of cancer. Results: A total of 180 patients with mean age of 49.68 years, with 62.2% females and 37.8% males were selected. Out of these 124 (68.89%) patientsreceived inadequate assessment for their pain intensity as no documented pain scale was being used to assess them. Out of them 50(49.02%) were males and 52 (50.98%) were females. 56 patients (31.11%) were receiving inadequate pain assessment. 17 (30.35%) of them were assessed using VAS and 39 (69.65%) were assessed using NRS. The median pain score was 7.8/10 with the stage 4 patients mainly presenting with a score of >7/10 (69.94%) and stage 3 patients making up majority of pain with <7/10 score (58.82%). Conclusion: This study showed that pain is poorly managed in patients with advanced malignancy as majority of patients are not assessed according to standard methods for cancer pain. There is a strong need of physicians’ education, development of proper palliative care services and implementation of WHO guidelines to achieve effective pain management for oncology patients. 

Development of a spiritual pain assessment sheet for terminal cancer patients: Targeting terminal cancer patients admitted to palliative care units in Japan

2006 ◽  
Vol 4 (2) ◽  
pp. 179-188 ◽  
Author(s):  
KEIKO TAMURA ◽  
KAORI ICHIHARA ◽  
EIKO MAETAKI ◽  
KEIKO TAKAYAMA ◽  
KUMI TANISAWA ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Three Dimensions ◽  
Terminal Cancer ◽  
Philosophical Perspective ◽  
Terminal Cancer Patients ◽  
Assessment Sheet ◽  
Palliative Care Units

Objective: This research explores the potential benefit of a spiritual pain assessment sheet to clinical practice. With spiritual pain defined as “pain caused by extinction of the being and meaning of the self,” the spiritual pain assessment sheet was developed by Hisayuki Murata from his conceptual framework reflecting the three dimensions of a human being as a being founded on temporality, a being in relationship, and a being with autonomy. The assessment sheet was developed from reviews of the literature and examinations from a philosophical perspective on the structure of spiritual pain.Methods: Patients admitted to palliative care units in Japan were interviewed using the assessment sheet. The responses were analyzed qualitatively. The usefulness of the assessment sheet and the burden placed on the patients by its use were also investigated.Results: The spiritual pain elucidated by the assessment sheet was the same as that revealed in the earlier research of Morita. The patients reported that they did not find the use of the assessment sheet a burden, and more than half reported that it was useful. The burden of the assessment sheet on the subjects was thus determined to be low. Positive feedback on the assessment sheet was also received from the nurses who conducted the patient interviews, who said the assessment sheet made it easier to talk with the patients about their spiritual pain.Significance of research: The research results indicate that the spiritual pain assessment sheet provided an appropriate assessment of spiritual pain among terminal cancer patients, showing that such a sheet could be used as an assessment tool in the future.

Serious illness conversation and end of life care utilization at an academic medical center.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 29-29
Author(s):  
William P. Tompkins ◽  
Christine Agnes Ciunci ◽  
Suzanne Walker ◽  
Kelly Patton ◽  
Amy Schwartz ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Median Time ◽  
Medical Center ◽  
Time Interval ◽  
Inpatient Setting ◽  
Serious Illness ◽  
Life Planning ◽  
End Of Life Planning

29 Background: Hospice has been associated with improved quality of life for patients, cost savings, and reduction in caregiver-grief-related depression. While cancer patients make up a plurality of hospice utilizers nationally, many patients are only on hospice for a limited period (in Medicare patients, a median of 18 days). Studies suggest engaging cancer patients to discuss goals and priorities using the Serious Illness Conversation (SIC) Guide has a positive impact on prognostic understanding and end-of-life planning. More frequent utilization of SICs may prompt earlier enrollment of oncology patients in hospice when appropriate. Methods: We identified cancer patients enrolled in hospice at the Abramson Cancer Center at Penn Presbyterian Medical Center from 2019-2020 after all providers received SIC training. Patient demographics, cancer diagnosis, type of hospice (home versus inpatient), SIC usage, palliative care referral patterns and time on hospice were abstracted. Results: 104 patients were enrolled in hospice during the study period. The majority of patients were female (51%). 45% were Caucasian, and 31% were African American. The most common cancer diagnoses were thoracic (52%) and gastrointestinal (32%) malignancies. 85 patients (82%) were enrolled on home hospice and 19 patients (18%) inpatient hospice. Palliative care usage included 50 inpatient and 24 outpatient consultations; 30 patients (29%) in the cohort never utilized palliative care. 52 (50%) of patients did not have a SIC. 47% (40 patients) enrolled in home hospice had an SIC while 63% (12 patients) on inpatient hospice had an SIC. The median time interval between a patient’s SIC conversation and hospice enrollment was longer in home hospice patients (74 days) compared to inpatient hospice (33 days). Patients on home hospice spent an average of 44 days on hospice versus 2 days in the inpatient setting. Conclusions: Half of the patients at Penn Presbyterian Medical Center enrolled in hospice during the study period did not have an SIC, and 29% did not see palliative care prior to starting hospice. The median time from SIC initiation to hospice enrollment was significantly longer for patients on home hospice compared to inpatient hospice suggesting a need for earlier SIC interventions. Patients enrolled in inpatient hospice spent a considerably shorter period of time on hospice also underscoring the importance of earlier end of life planning. Our findings indicate a need for additional interventions to facilitate earlier SIC conversations in the outpatient setting and a demand for increased palliative care access.

The revised FLACC score: Reliability and validation for pain assessment in children with cerebral palsy

2015 ◽  
Vol 9 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Line Kjeldgaard Pedersen ◽  
Ole Rahbek ◽  
Lone Nikolajsen ◽  
Bjarne Møller-Madsen
Keyword(s):  
Cerebral Palsy ◽  
Pain Management ◽  
Postoperative Pain ◽  
Pain Score ◽  
Pain Assessment ◽  
Reliability And Validity ◽  
Measurement Properties ◽  
Cosmin Checklist ◽  
Children With Cerebral Palsy

AbstractBackground and aimsPain in children with cerebral palsy (CP) is difficult to assess and is therefore not sufficiently recognized and treated. Children with severe cognitive impairments have an increased risk of neglected postoperative, procedural and chronic pain resulting in decreased quality of life. The r-FLACC (revised Face, Legs, Activity, Cry and Consol ability) pain score is an internationally acclaimed tool for assessing pain in children with CP because of its ease to use and its use of core pain behaviours. In addition the r-FLACC pain score may be superior to other pain assessment tools since it includes an open- ended descriptor for incorporation of individual pain behaviours. The COSMIN group has set up three quality domains, which describe the quality of Health-Related Patient-Reported Outcomes (HR-PROs). These are reliability (internal consistency, reliability and measurement error), validity (content validity, construct validity and criterion validity) and responsiveness. The r-FLACC score has only been assessed for reliability and validity in the original English version by the developers of the score. The aim of this study is to assess reliability and validity of the r-FLACC pain score for use in Danish children with CP.MethodsTwenty-seven children aged 3–15 years old with CP were included after orthopaedic surgery. Two methods for assessment of postoperative pain were used. Pain intensity was assessed by r-FLACC, with a 2 min standardized video recording of the child, and the Observational Visual Analogue Score (VAS-OBS) assessed by the parents. The COSMIN checklist was used as a guideline in the reliability and validity testing of the r-FLACC score.ResultsReliability was supported by three measurement properties. Internal consistency was excellent with a Cronbachs alpha of 0.9023 and 0.9758 (two raters). A factor analysis of the subgroups in the r-FLACC score showed unidimensionality. A test-retest showed excellent intra-rater reliability with an intraclass correlation (ICC) of 0.97530. Inter-rater reliability was acceptable with an ICC of 0.74576. Validity was supported by three measurement properties. Content validity was tested by the originators of the r-FLACC. Construct validity was supported by a significant increase in r-FLACC scores following surgery (n = 17; difference 2.23; p = 0.0397). Criterion validity was acceptable with Pearson’s correlation coefficients of 0.76 and 0.59 when comparing r-FLACC scores and VAS-OBS scores.Conclusions and implicationsThis study benefits from a systematical approach to the validation and reliability parameters by using the COSMIN checklist as a guideline. It is evident that the r-FLACC pain score maintains its psychometric properties after translation. In conclusion, the r-FLACC pain score is valid and reliable in assessing postoperative pain in children with CP not able to self-report pain. With the r-FLACC pain score clinicians have a valid tool for assessing postoperative pain, hence increasing the quality of pain management in children with CP. In addition the validated r-FLACC score has the potential for use in interventional research regarding pain management in this vulnerable group of patients. Future perspectives include validation of the r-FLACC score for procedural and chronic everyday pain and implementation into daily practice.

Impact of palliative care clinic (PCC) referrals on pain control in genitourinary (GU) cancer patients: Retrospective analysis at Roswell Park Cancer Institute (RPCI).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 57-57
Author(s):  
Neha Gupta ◽  
Shipra Gandhi ◽  
Sidra Anwar ◽  
Katy Wang ◽  
Yashodhara Satchidanand
Keyword(s):  
Palliative Care ◽  
Pain Score ◽  
Cancer Patients ◽  
Retrospective Review ◽  
Pain Control ◽  
Medical Oncology ◽  
Screening Tools ◽  
Chi Square ◽  
Care Clinic

57 Background: Many cancer patients (pts) with GU cancer suffer from uncontrolled pain, and may benefit from more focused palliative care. We assessed the frequency and impact of specialist PCC referrals on pain management of our GU Medical oncology clinic (GUMOC) pts. Methods: 239 consecutive pts were collected from a retrospective review of GUMOC records from 12/1/2013 to 2/28/2014. This group of pts was used to assess the frequency of PCC referral. Pts were divided into two arms- Arm A= GUMOC pts referred to PCC; Arm B: GUMOC pts not referred to PCC. To be able to detect a 15% between the two arms at 95% significance, 37 additional pts (who were already being seen at GUMOC) were collected from retrospective review of PCC records over 9/1/2013 to 2/28/2014. Total 276 pts were divided into Arm A (n=49), Arm B (n=227 pts). Data for baseline pain score and 4-week follow up pain scores were collected. A palliative care screening tool (retrieved from Center to Advance Palliative care [CAPC] website) was used to assign palliative care screening score (PCSS) to all study pts. Chi square test and T-test were used for statistical analysis. Results: Out of the 239 initially collected GUMOC pts, 5% were referred to PCC. 10% (n=24) had PCSS score of ≥ 4, and 33% pts with PCSS ≥ 4 were referred to PCC. Arm A had worse baseline symptoms, ECOG status and more advanced cancer stage. 4-week pain score follow up revealed significant improvement in Arm A -2.74 vs. Arm B -0.13 (p<0.01). Conclusions: GU cancer pts who are referred to PCC from medical oncology clinic have significant decrease in pain symptoms. Frequency of PCC consultation is still low in comprehensive cancer institutes, and not in congruence with the available palliative care screening tools criteria suggested by CAPC. Standardized tools should be developed to guide PCC referrals, and routine use of these tools will significantly help in pain control by seeking specialist palliative care.

Making the case for outpatient palliative care for cancer patients at a safety-net hospital.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 310-310
Author(s):  
Heather A. Harris ◽  
Anne Kinderman ◽  
Kathleen Kerr
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Average Length ◽  
Safety Net ◽  
Direct Costs ◽  
Cost Of Care ◽  
Initial Contact ◽  
Course Of Illness ◽  
Cancer Registry Data ◽  
Safety Net Hospital

310 Background: Prior research has shown that patients who receive earlier, outpatient palliative care (OP PC) have improved end-of-life care compared to patients who receive only inpatient palliative care (IP PC). We examined the need, expected impact and feasibility of providing OP PC to patients with cancer seen at our hospital, which offers IP PC but not OP PC. Methods: Retrospective cohort study of patients cared for at our urban, safety-net hospital who died of cancer between July 2010 and June 2013. We used cancer registry data to identify decedents and claims data to evaluate utilization patterns, contacts with our IP PC service, and cost of care in the final 6 months of life. Results: In the analysis period 403 patients died of cancer, 307 of whom were admitted to the hospital in the 6 months preceding death. On average patients were admitted 1.9 times, with 39% having multiple admissions. Average length of stay was 10.47 days. Nearly half of all patients were admitted to the hospital in the final month of life (181/403), and 21% of those (38/181) had multiple admissions. One third of patients died in the hospital and another 4% died within 3 days of hospital discharge. Direct costs per admission averaged $22,275. The IP PC service had contact with 178 patients; 44% of the entire decedent population and 58% of those who were hospitalized. In 60% of cases the initial contact with the PC team took place in the final month of life. We determined that 33% of patients had multiple inpatient and or outpatient encounters 90-180 days prior to death, pointing to an expected annual clinic volume of about 50 patients. Annual costs for staffing a clinic that could follow 50 patients for an average of 4 months were estimated at $88,290. We assumed that providing OP PC would reduce utilization of inpatient services by 40% (38 avoided admissions), with resulting avoided direct costs of $846,450. Conclusions: At our facility cancer patients often receive aggressive EOL care. Our IP PC team sees many of these patients, but most contacts occur days-weeks prior to death. Though many patients present very late in the course of illness, a substantial number have multiple health system contacts >3 months prior to death, and could be referred to an OP PC clinic.

scholarly journals Race/Ethnicity, Primary Language, and Income Are Not Demographic Drivers of Mortality in Breast Cancer Patients at a Diverse Safety Net Academic Medical Center

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Divya A. Parikh ◽  
Rani Chudasama ◽  
Ankit Agarwal ◽  
Alexandar Rand ◽  
Muhammad M. Qureshi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Safety Net ◽  
Primary Language ◽  
Breast Cancer Patients ◽  
Patient Demographics ◽  
Academic Medical ◽  
Race Ethnicity

Objective. To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center.Patients and Methods. 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012.Results. There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37,p=0.006), age > 70 years (OR = 3.88, CI = 1.13–11.48,p=0.014), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06,p<0.0001).Conclusions. In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.

scholarly journals Analysis of Severe Pain and its Treatment in a Palliative Care Unit in a Regional Cancer Centre

2017 ◽  
Vol 7 (3) ◽  
pp. 103
Author(s):  
Kannan P ◽  
Gunaseelan K ◽  
Parthasarathy V
Keyword(s):  
Palliative Care ◽  
Cancer Pain ◽  
Pain Score ◽  
Cancer Patients ◽  
Severe Pain ◽  
Palliative Care Unit ◽  
Cancer Centre ◽  
Prevalence Of Pain ◽  
Regional Cancer Centre

<p><strong>Objective</strong>: Pain is one of the most common symptoms that troubles cancer patients and precludes satisfactory quality of life. Globally, nearly 80% of the cancer patients receive little or no pain medication and cancer pain is barely controlled. This study was done to analyse the prevalence of pain and pain treatment in patients presenting to palliative care unit in a regional cancer centre.</p><p><br /><strong>Methods</strong>: Palliative care registry and follow-up forms of 2142 patients who got registered in our palliative care unit were analysed to obtain the demographic details, treatment characteristics and to determine the prevalence of pain, its severity, and treatment in cancer patients in our regional cancer centre.</p><p><br /><strong>Results</strong>: Nearly 50% of the cancer population had head and neck and gastrointestinal tract malignancies and received only best supportive care. Stage IV disease was found in 40% of patients, and skeletal metastasis (52%) was most common. This study showed a 92.4% prevalence of cancer pain in our centre. About 40% of patients with pain had a pain score of 7-10 by Numerical rating scale on initial presentation to the palliative care unit. About 65% of the patients with severe pain had a response to treatment withmorphine during their first follow-up to palliative care unit after initial registration. The average overall pain score of the patients per visit decreased from around 7 to 4 at a median follow-up of ten months.</p><p><br /><strong>Significance of results</strong>: Thus, there is a high prevalence of pain in cancer patients and patients with severe pain receive little or no opioid medication at all probably due to the lack of adequate education and training to the primary oncologists and residents regarding prescription of strong opioids. This audit may help in the modification of existing and formulation of new policies in the delivery of palliative care.</p>

Pain assessment behavioral scale in agonic cancer patients: Experience in total care—An end-of-life care home service.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19636-e19636
Author(s):  
Maricarmen Alfaro ◽  
Raquel Baldeos ◽  
Beatriz Rosales ◽  
Maria Berenguel ◽  
Alfredo Aguilar
Keyword(s):  
Pain Score ◽  
Cancer Patients ◽  
Pain Assessment ◽  
Severe Pain ◽  
Care Home ◽  
Self Report ◽  
Moderate Pain ◽  
Primary Tumors ◽  
Mild Pain ◽  
Behavioral Scale

e19636 Background: Assessing pain in nonverbal, especially agonic cancer patients is a great challenge. In the absence of self-report, measurement of pain could be difficult and patient`s behavior could be useful. The aim of this work was to evaluate the Pain Assessment Behavioral Scale (PABS) in cancer agonic patients. Methods: PABS scale was used to evaluate 118 cancer patients enter in agony. Pain levels was categorized according to PABS score in Mild Pain (score 1-3), Moderate Pain (score 4-5), Severe Pain (score>6). We correlated levels of pain with age, sex, cancer metastatic site or active tumor localization with the ANOVA, Chi square or Fisher tests when were appropriated. A P<0.05 was considered significant. Results: Fifty two patients (44.1%) were male and 66 female (55.9%). The median age was 74 (Standar Deviation [SD]:13.1; Range: 30-94). Most frequent primary tumors were colorectal (16%), lung (11%), Pancreas (9.3%), Breast (8.5%), lymphomas (6.8%), prostate (6.8%) and gastric (5.6%) cancer. Involvement of primary active tumor or active metastases was present in lung (22%), Central Nervous System (CNS) (13.6%), liver (22%), and bone (7.6%). The median of PABS score was 5 (SD=1.25; range: 2 – 8). Seven cases had mild pain (5.9%), 105 moderate pain (89%) and 6 severe pain (5.1%). There was no correlation of pain levels with age (P=0.420), sex (P=0.098), active tumor or metastatic involvement of lung (P=0.321), CNS (P=0.972), Liver (P=0.575) or bone (P=0.529). Conclusions: In our experience, PABS scale is a useful tool to evaluate pain in agony cancer patients. We found no correlation between active tumor or metastatic localization with the intensity of pain.

scholarly journals Factors associated with the wish to hasten death: a study of patients with terminal illness

2002 ◽  
Vol 33 (1) ◽  
pp. 75-81 ◽  
Author(s):  
B. KELLY ◽  
P. BURNETT ◽  
D. PELUSI ◽  
S. BADGER ◽  
F. VARGHESE ◽  
...  
Keyword(s):  
Social Support ◽  
Palliative Care ◽  
Cancer Patients ◽  
Social Issues ◽  
Terminally Ill ◽  
Physical Symptoms ◽  
Therapeutic Interventions ◽  
Treatment Needs ◽  
Terminally Ill Cancer Patients ◽  
Wish To Hasten Death

Background. There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions.Method. A sample of terminally ill cancer patients (N=256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998–2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated.Results. A high WTHD was reported by 14% of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P<0·001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms.Conclusions. Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.

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