Lymphoedema and oedema in palliative care patients

2021 ◽  
Vol 26 (Sup4) ◽  
pp. S6-S15
Author(s):  
Sinéad Cobbe
Keyword(s):  
Palliative Care ◽  
Head And Neck ◽  
Clinical Reasoning ◽  
Patient Comfort ◽  
Care Community ◽  
Complex Cases

Oedema and lymphoedema commonly occur in patients receiving palliative care. Community nurses frequently manage both in the home or must decide to refer for medical or specialist lymphoedema assessment. This article describes the types of oedema seen in palliative care and assists in clinical reasoning around the type of oedema presented and when to refer onwards. The treatments for palliative care oedema and lymphoedema are described, including how to adapt for complex cases and for patient comfort. Genital swelling, abdominal swelling, head and neck oedema and lymphorrhoea are also discussed.

scholarly journals 523. COVID-19 Preparedness in Hospice and Palliative Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S328-S328
Author(s):  
Monika Pogorzelska-Maziarz ◽  
Jeannette Kates ◽  
Jingjing Shang ◽  
Angela M Gerolamo
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Group Discussion ◽  
Discussion Board ◽  
Community Group ◽  
Care Community ◽  
Care Services ◽  
Do It Yourself ◽  
Hospice And Palliative Care ◽  
The Impact

Abstract Background Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed. Results We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate. Disclosures All Authors: No reported disclosures

scholarly journals Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies

2018 ◽  
pp. bmjspcare-2018-001579 ◽  
Author(s):  
Daniel Munday ◽  
Vandana Kanth ◽  
Shadrach Khristi ◽  
Liz Grant
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Community Health ◽  
Low Income ◽  
Integrated Management ◽  
Premature Mortality ◽  
Communicable Diseases ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Care Community

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

scholarly journals Shared electronic care coordination systems following referral to hospice

2021 ◽  
Vol 26 (2) ◽  
pp. 58-62
Author(s):  
Libby Sampey ◽  
Anne M Finucane ◽  
Juliet Spiller
Keyword(s):  
Palliative Care ◽  
Service Evaluation ◽  
Health Providers ◽  
Specialist Palliative Care ◽  
Community Nurse ◽  
Structured Interviews ◽  
Out Of Hours ◽  
Care Community ◽  
Palliative Care Teams ◽  
Coordination Systems

In Scotland, the Key Information Summary (KIS) enables health providers to access key patient information to guide decision-making out-of-hours. KISs are generated in primary care and rely on information from other teams, such as community specialist palliative care teams (CSPCTs), to keep them up-to-date. This study involved a service evaluation consisting of case note reviews of new referrals to a CSPCT and semi-structured interviews with palliative care community nurse specialists (CNSs) regarding their perspectives on KISs. Some 44 case notes were examined, and 77% of patients had a KIS on CSPCT referral. One-month post-referral, all those re-examined (n=17) had a KIS, and 59% KISs had been updated following CNS assessments. CNSs cited anticipatory care planning (ACP) as the most useful aspect of KIS, and the majority of CNSs said they would appreciate KIS editing access. A system allowing CNSs to update KISs would be acceptable to CNSs, as it could facilitate care co-ordination and potentially improve comprehensiveness of ACP information held in KISs.

scholarly journals Use of inpatient palliative care services in patients with metastatic incurable head and neck cancer

Head & Neck ◽  
2015 ◽  
Vol 38 (3) ◽  
pp. 355-363 ◽  
Author(s):  
Carolyn L. Mulvey ◽  
Thomas J. Smith ◽  
Christine G. Gourin
Keyword(s):  
Palliative Care ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Care Services ◽  
Palliative Care Services

Surgical Palliative Care

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.

Disease-modifying therapies in advanced cancer

2021 ◽  
pp. 800-807
Author(s):  
Olav Dajani ◽  
Karin Jordan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Well Being ◽  
Patient Comfort ◽  
Optimal Care ◽  
Disease Modifying ◽  
Critical Components ◽  
Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

scholarly journals Disease trajectories, place and mode of death in people with head and neck cancer: Findings from the ‘Head and Neck 5000’ population-based prospective clinical cohort study

2020 ◽  
Vol 34 (5) ◽  
pp. 639-650 ◽  
Author(s):  
Catriona R Mayland ◽  
Kate Ingarfield ◽  
Simon N Rogers ◽  
Paola Dey ◽  
Steven Thomas ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Population Based ◽  
Hospital Death ◽  
Care Needs ◽  
Curative Intent ◽  
Mode Of Death

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with ‘non-curative’ and ‘curative’ intent, respectively. Within 12 months, 109/161 (68%) in the ‘non-curative’ group died compared with 482/5241 (9%) in the ‘curative’ group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in ‘non-curative’ and ‘curative’ groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% ‘non-curative’; 23.5% ‘curative’) and 45.7% of the ‘curative’ group died in hospital. Conclusion: In addition to those with incurable head and neck cancer, there is a small but significant ‘curative’ subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.

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