Screening and Assessment Tools for Measuring Delirium in Patients with Cancer in Hospice and Palliative Care: A Systematic Review

BackgroundPain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.ObjectiveTo critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.MethodsMultiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.ResultsFive studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.ConclusionsAcupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

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What is the impact of Specialist Palliative Care Outpatient Consultations’ on Pain in Adult Patients’ with cancer? A systematic review

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2021.102034 ◽

2021 ◽

pp. 102034

Author(s):

Liam Patton ◽

Pinar Avsar ◽

Dr Linda Nugent ◽

Tom O’Connor ◽

Declan Patton ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Adult Patients ◽

Specialist Palliative Care ◽

Patients With Cancer ◽

The Impact

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Medical student confidence in care of the dying and their family: a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-001977 ◽

2020 ◽

pp. bmjspcare-2019-001977

Author(s):

Geoffrey Wells ◽

Elaney Youssef ◽

Rebecca Winter ◽

Juliet Wright ◽

Carrie Llewellyn

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Medical Student ◽

Cochrane Review ◽

Assessment Tools ◽

Junior Doctors ◽

Medical Council ◽

Dying Patients ◽

Medical Undergraduate ◽

Student Confidence

BackgroundThe General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying.AimThis systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients.DesignA systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools and details of applied educational interventions. Pre/postintervention confidence comparisons were made. Factors influencing confidence levels were explored.Data sourcesMEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsycINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’ and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool.ResultsFifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased postinterventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence.ConclusionThis review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning.PROSPERO registration numberCRD42019119057.

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Systematic Review on the Influencing Factors of Nursesʼ and Nursing Studentsʼ Attitudes Toward Hospice and Palliative Care

Journal of Hospice and Palliative Nursing ◽

10.1097/njh.0000000000000627 ◽

2020 ◽

Vol 22 (2) ◽

pp. 130-136

Author(s):

Sung Hoon Jeong ◽

So Jeong Lee ◽

Seul Min Cho ◽

Hyun Cho

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Influencing Factors ◽

Hospice And Palliative Care

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Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2018.07.016 ◽

2018 ◽

Vol 56 (5) ◽

pp. 781-794.e4 ◽

Cited By ~ 19

Author(s):

Yvette S. Zeng ◽

Connie Wang ◽

Kristina E. Ward ◽

Anne L. Hume

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Alternative Medicine ◽

Complementary And Alternative Medicine ◽

Hospice And Palliative Care ◽

Complementary And Alternative

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Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature

Cardio-Oncology ◽

10.1186/s40959-021-00117-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Anecita P. Fadol ◽

Ashley Patel ◽

Valerie Shelton ◽

Kate J. Krause ◽

Eduardo Bruera ◽

...

Keyword(s):

Heart Failure ◽

Palliative Care ◽

Symptom Burden ◽

Cochrane Library ◽

Early Integration ◽

Patients With Cancer ◽

Ovid Medline ◽

Referral Criteria ◽

Patient Reported ◽

Hospice And Palliative Care

Abstract Background Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. Aims To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. Design Systematic literature review on PC in patients with HF and in patients with cancer. Data sources Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. Results Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. Conclusion The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

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Oxford Textbook of Palliative Medicine

10.1093/med/9780199656097.001.0001 ◽

2015 ◽

Cited By ~ 25

Keyword(s):

Palliative Care ◽

Palliative Medicine ◽

Assessment Tools ◽

Global Perspective ◽

Very Old ◽

Patients With Cancer ◽

Emerging Topics

This new edition of the Oxford Textbook of Palliative Medicine has been thoroughly updated to offer a truly global perspective in this field, and new sections include information on assessment tools, care of patients with cancer, and the management of issues in the very young and the very old. It covers all the new and emerging topics, and the multi-disciplinary nature of palliative care is emphasized throughout, covering areas from ethical and communication issues, the treatment of symptoms, and the management of pain.

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The incidence and prevalence of delirium across palliative care settings: A systematic review

Palliative Medicine ◽

10.1177/0269216319854944 ◽

2019 ◽

Vol 33 (8) ◽

pp. 865-877 ◽

Cited By ~ 24

Author(s):

Christine L Watt ◽

Franco Momoli ◽

Mohammed T Ansari ◽

Lindsey Sikora ◽

Shirley H Bush ◽

...

Keyword(s):

Systematic Review ◽

Palliative Care ◽

Data Extraction ◽

Risk Of Bias ◽

Point Prevalence ◽

Assessment Tools ◽

Included Patient ◽

Study Heterogeneity ◽

Palliative Care Units ◽

Meta Analyses

Background: Delirium is a common and distressing neurocognitive condition that frequently affects patients in palliative care settings and is often underdiagnosed. Aim: Expanding on a 2013 review, this systematic review examines the incidence and prevalence of delirium across all palliative care settings. Design: This systematic review and meta-analyses were prospectively registered with PROSPERO and included a risk of bias assessment. Data sources: Five electronic databases were examined for primary research studies published between 1980 and 2018. Studies on adult, non-intensive care and non-postoperative populations, either receiving or eligible to receive palliative care, underwent dual reviewer screening and data extraction. Studies using standardized delirium diagnostic criteria or valid assessment tools were included. Results: Following initial screening of 2596 records, and full-text screening of 153 papers, 42 studies were included. Patient populations diagnosed with predominantly cancer ( n = 34) and mixed diagnoses ( n = 8) were represented. Delirium point prevalence estimates were 4%–12% in the community, 9%–57% across hospital palliative care consultative services, and 6%–74% in inpatient palliative care units. The prevalence of delirium prior to death across all palliative care settings ( n = 8) was 42%–88%. Pooled point prevalence on admission to inpatient palliative care units was 35% (confidence interval = 0.29–0.40, n = 14). Only one study had an overall low risk of bias. Varying delirium screening and diagnostic practices were used. Conclusion: Delirium is prevalent across all palliative care settings, with one-third of patients delirious at the time of admission to inpatient palliative care. Study heterogeneity limits meta-analyses and highlights the future need for rigorous studies.

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