A Guide to Symptom Relief in Palliative Care

Background and Purpose: Palliative care is an essential part of ICH care, particularly in patients with high ICH scores given their poor prognosis. Palliative care involves consultation by the Palliative Care Service and includes de-escalation of care, changing code status, and making pain and symptom relief the central goal of management. Methods: We performed a retrospective review of consecutive patients presenting to our tertiary care center from 2008-2013 with primary ICH. Demographic and clinical data were collected. Our sample included only patients who died or were transferred to hospice. We examined the proportion of patients that received an inpatient palliative care consult and compared this group to patients who did not receive an inpatient palliative care consult. Patients were categorized by ICH score. Results: Of the 99 ICH patients who died or were discharged to hospice, only 23% received a palliative care consult. Figure 1 displays death, predicted death, and palliative care consult proportions by ICH score. Patients that received a Palliative Care consult were older (mean age 65 vs. 73, p=0.018) and more frequently had evidence of infection (32% vs. 13%, p=0.038); no other significant differences were found between groups. Conclusions: In our sample of ICH patients, 23% of patients received a palliative care consult. In those with high ICH scores utilization was only 28%, despite 30 day expected mortality of 97% or greater. This raises concern that palliative care may be underutilized in patients who may benefit from it the most.

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Surgical Palliative Care

10.2310/vasc.2014 ◽

2018 ◽

Author(s):

Zara Cooper ◽

Emily B. Rivet

Keyword(s):

Decision Making ◽

Palliative Care ◽

End Of Life ◽

Symptom Relief ◽

Psychological Needs ◽

Sudden Onset ◽

Transitions Of Care ◽

Patient Comfort ◽

Health State ◽

Surgery Patient

Palliative care is a multidisciplinary approach to care that includes relief of suffering and attention to the social, spiritual, physical, and psychological needs of patients and families. The intent of palliative care is to help patients live as well as possible for as long as possible, and relevant domains of palliative care include symptom relief, prognostication, communication with patients, families and clinicians, transitions of care, and end-of-life care. Palliative care is distinct from hospice in many respects including that it can be provided simultaneously with recovery-directed treatments rather than reserved for individuals at end of life. Patients with surgical disease are particularly in need of palliative care due to the common occurrence of severe symptoms such as pain and nausea, complex decision-making, and the often sudden onset of the disease or injury which precludes preparation for the new health state. Key Words: communication, end-of- life, goals of care, high-risk surgery, palliative, palliative care, palliative surgery, patient comfort, surgical decision-making, surgical prognostication This review contains 3 figures, 10 tables, and 61 references.

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Palliative care and symptom relief for people affected by multidrug-resistant tuberculosis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.18.0428 ◽

2019 ◽

Vol 23 (8) ◽

pp. 881-890

Author(s):

E. L. Krakauer ◽

K. Dheda ◽

B. Kalsdorf ◽

L. Kuksa ◽

A. Nadkarni ◽

...

Keyword(s):

Palliative Care ◽

Symptom Relief ◽

Multidrug Resistant ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis

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Can Symptom Relief Be Provided in the Home to Palliative Care Cancer Patients by the Primary Caregivers?

Cancer Nursing ◽

10.1097/ncc.0000000000000098 ◽

2014 ◽

Vol 37 (5) ◽

pp. E40-E47 ◽

Cited By ~ 7

Author(s):

Sheeba Chellappan ◽

Punitha Ezhilarasu ◽

Angela Gnanadurai ◽

Reena George ◽

Solomon Christopher

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Symptom Relief ◽

Primary Caregivers

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Integrating palliative care and symptom relief into responses to humanitarian crises

The Medical Journal of Australia ◽

10.5694/mja2.50295 ◽

2019 ◽

Vol 211 (5) ◽

pp. 201 ◽

Cited By ~ 4

Author(s):

Eric L Krakauer ◽

Bethany‐Rose Daubman ◽

Tammam Aloudat

Keyword(s):

Palliative Care ◽

Symptom Relief ◽

Humanitarian Crises

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Blood concentrations of vitamins B1, B6, B12, C and D and folate in palliative care patients: Results of a cross-sectional study

Journal of International Medical Research ◽

10.1177/0300060519875370 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6192-6205

Author(s):

Claudia Vollbracht ◽

Peter W Gündling ◽

Karin Kraft ◽

Iris Friesecke

Keyword(s):

Palliative Care ◽

Symptom Relief ◽

Univariate Analysis ◽

Vitamin B1 ◽

Vitamin B12 Deficiency ◽

Cross Sectional Study ◽

Vitamin Supplementation ◽

Sectional Study ◽

Cross Sectional ◽

Blood Concentrations

Objective The main purpose of palliative care is symptom relief. Frequently, the symptoms of patients requiring palliative care are the same as common symptoms of vitamin deficiency (e.g. pain, weakness, fatigue, depression). The study aim was to investigate whether patients in palliative care are vitamin deficient. Method This was a monocentre cross-sectional study. Patients attending the palliative care unit of a general hospital in Germany from October 2015 to April 2016 were examined for vitamin blood concentrations and symptoms. Data were analysed using univariate analysis and bivariate correlations. Results Data were available from 31 patients. Vitamin D3 deficiency (<62.5 nmol/L) affected 93.5% of patients, vitamin B6 deficiency (<4.1 ng/mL) 48.4%, vitamin C deficiency (<4.5 mg/L) 45.2%, vitamin B1 deficiency (<35 µg/L) 25.8% and vitamin B12 deficiency (<193 pg/mL) 12.9%. There was a significant negative correlation between vitamin B1 ranges and pain (r = −0.384) and depression (r = −0.439) symptoms. Conclusion All patients showed a deficiency in at least one of the measured vitamins; 68% had concurrent deficiencies in >1 vitamin. A follow-up study using validated questionnaires and a larger sample is needed to investigate the effects of targeted vitamin supplementation on quality of life and symptom burden.

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Patients With Fibrotic Interstitial Lung Disease Receive Supportive and Palliative Care Just Prior to Death

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120938629 ◽

2020 ◽

Vol 38 (2) ◽

pp. 154-160

Author(s):

Natasha Smallwood ◽

Jennifer Mann ◽

Hui Guo ◽

Nicole Goh

Keyword(s):

Palliative Care ◽

Symptom Relief ◽

Oral Morphine ◽

Forced Expiratory Volume ◽

Interstitial Lung Diseases ◽

Teaching Hospitals ◽

Early Palliative Care ◽

Retrospective Audit ◽

Oral Morphine Equivalent ◽

Symptom Palliation

Background: Fibrotic interstitial lung diseases (f-ILDs) are often progressive and incurable. As patients experience significant symptoms and have a poor prognosis, early palliative care referral is recommended. Objective: To examine the care delivered to patients with f-ILD during the terminal hospital admission and the past 2 years of life. Methods: A retrospective audit was performed for consecutive patients who died from f-ILD at 2 Australian teaching hospitals between January 1, 2012, and December 31, 2016. Results: Of 67 patients, 44 (66%) had idiopathic pulmonary fibrosis. Median age was 78 years. Median respiratory function: forced expiratory volume in 1 second 69.0% predicted (interquartile range [IQR]: 58.0%-77.0%), forced vital capacity 64.0% predicted (IQR = 46.8%-74.3%), and diffusing capacity of carbon monoxide 36.0% predicted (IQR = 31.0%-44.0%). In the 2 years prior to the terminal admission, 38 (57%) patients reported severe breathlessness and 17 (25%) used opioids for symptom relief. Twenty-four (36%) patients received specialist palliative care (SPC) and 11 (16%) completed advance care planning. During the terminal admission, 10 (15%) patients were admitted directly under SPC. A further 33 (49%) patients were referred to SPC, on average 1 day prior to death. Sixty-three (94%) patients received opioids and 49 (73%) received benzodiazepines for symptom management. Median starting and final opioid doses were 10 and 23 mg oral morphine equivalent/24 hours, respectively. Opioids were commenced on average 2 (IQR 1-3) days prior to death. Conclusions: Although most patients were identified as actively dying in the final admission, referral to SPC and use of palliative medications occurred late. Additionally, few patients accessed symptom palliation earlier in their illness.

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Evaluating a Palliative Care Program: Methodology and limitations

Journal of Palliative Care ◽

10.1177/082585979601200206 ◽

1996 ◽

Vol 12 (2) ◽

pp. 23-33 ◽

Cited By ~ 20

Author(s):

Hilary Jarvis ◽

Frederick I. Burge ◽

Chris A. Scott

Keyword(s):

Palliative Care ◽

Symptom Relief ◽

Tertiary Care ◽

Palliative Care Service ◽

Care Facility ◽

Maslach Burnout Inventory ◽

Symptom Distress ◽

Community Resources ◽

Tertiary Care Facility ◽

Distress Scale

The article describes an evaluation of a palliative care service in a regional and tertiary care facility. The service components are described. The four outcomes chosen for evaluation were: (a) symptom relief; (b) satisfaction with care for patients/families; (c) utilization of community resources; (d) good nursing morale and low staff stress. Quality of life was measured using a symptom distress scale; satisfaction using an adapted Kristjanson FAMCARE scale; community resources with opinion and satisfaction surveys; and staff morale and stress with the Maslach Burnout Inventory and Latack's Coping Questionnaire. Results showed that overall symptom distress was reduced. Patients/families were generally satisfied, with some areas needing attention. Physicians were generally satisfied and believed patients/families benefited from the psychosocial support, respite, and education/information. Nurses felt they had the time, energy, resources and support to give quality care.

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Change in symptom burden within one day of palliative care consultation in a cohort of gynecologic oncology inpatients.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.28 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 28-28

Author(s):

Carolyn Lefkowits ◽

Winifred Teuteberg ◽

Madeleine Courtney-Brooks ◽

Paniti Sukumvanich ◽

Joseph L. Kelley

Keyword(s):

Palliative Care ◽

Symptom Management ◽

Severe Symptom ◽

Symptom Relief ◽

Gynecologic Oncology ◽

Symptom Burden ◽

Assessment System ◽

Palliative Care Consultation ◽

Symptom Intensity ◽

Care Consultation

28 Background: Change in symptom burden after inpatient palliative care consultation for symptom management in gynecologic oncology patients has not been described. Our objective was to evaluate the magnitude and time course of change in symptom burden after palliative care (PC) consultation in a cohort of gynecologic oncology inpatients. Methods: Women with a gynecologic malignancy and a PC consultation for symptom management between 3/1/12 and 2/28/13 were identified. Charts were reviewed for demographics and disease characteristics. PC provider reports of patient symptom intensity on a modified Edmonton Symptom Assessment System were retrospectively reviewed. Data was analyzed with descriptive statistics and two sample test of proportions to compare prevalence of moderate to severe symptom intensity on the day of consultation to the day after consultation. Results: Over 12 months, there were 172 PC consultations for symptom management involving 123 unique patients. The median age was 58 and most common cancer was ovarian (44%), followed by cervical (26%) and uterine (24%). Prevalence of moderate to severe symptoms on the day of consultation is outlined below. There were statistically significant decreases in prevalence of moderate to severe symptom intensity within one day of PC consultation for pain, anorexia, fatigue and shortness of breath (SOB) (see table). Conclusions: PC consultation is associated with significant improvements in symptoms within one day of consultation. Palliative care consultation may be an effective tool for symptom management during even very short hospitalizations and should be considered early in the hospitalization to effect timely symptom relief. [Table: see text]

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The sooner the better: Analysis of proactive palliative medicine consultation in the medical intensive care unit amongst patients with stage IV malignancy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.78 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 78-78

Author(s):

Shanna R Levine ◽

Earle I Bridget ◽

Wendy S.A. Edwards

Keyword(s):

Palliative Care ◽

Length Of Stay ◽

Hospital Stay ◽

Palliative Medicine ◽

Symptom Relief ◽

Stage Iv ◽

Active Stage ◽

Trigger Tool ◽

Goals Of Care ◽

Rehabilitation Facility

78 Background: Palliative care has been shown to improve quality of life and prolong median survival in patients with advanced cancer. Sadly, patients are still suffering at the end of their lives perhaps secondary to aggressive hospital care. ICU use in the last month of life increased from 24.3% to 29.2% over the last study decade. Our objective was to evaluate and quantify outcomes, including survival, of patients with active stage IV malignancy admitted to an urban university affiliated hospital MICU who had a palliative medicine consult. Methods: A retrospective chart review of patients from 04/2013 - 04/2014 admitted to the MICU with active stage IV malignancy identified via a validated proactive case finding trigger tool. The trigger was based on eight criteria, one of which being active stage IV malignancy. The MICU census was reviewed biweekly. Data collected included pain and symptom relief, clarification of goals of care, length of stay, and disposition (hospice, rehabilitation facility, home and death). Results: Four hundred sixty eight patients were assessed. One hundred and twenty two patients met 1 of the 8 criteria, and 24 patients met the inclusion criteria for review. Three patients were not seen due to attending and/or family preference. Thirty eight percent of patients had improved symptoms and management control, 42% had clarification of goals of care and medically appropriate decision making, and 42% experienced psychosocial spiritual counseling. Eight patients died during their hospital stay, 4 were transferred to inpatient hospice facilities, 3 to rehabilitation facility, 2 went home and the remainder was “other”. The average length of stay of patients seen by palliative care was 20 days compared to 31 days for patients not seen by the palliative team. Conclusions: Nearly 40% of patients with active stage IV malignancy admitted to the MICU died during their hospital stay. We believe this study illuminates the futility of ICU care in this patient population. Consultation from the palliative medicine team using a proactive trigger tool can be beneficial to allow for better symptom control, clarification of goals and psychosocial counseling.

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