scholarly journals Palliative Renal Care and the Covid-19 Pandemic

2020 ◽  
Vol 42 (2 suppl 1) ◽  
pp. 44-46
Author(s):  
Cássia Gomes da Silveira Santos ◽  
Alze Pereira dos Santos Tavares ◽  
Carmen Tzanno-Martins ◽  
José Barros Neto ◽  
Ana Maria Misael da Silva ◽  
...  
Keyword(s):  
Palliative Care ◽  
Healthcare Professionals ◽  
Standard Treatment ◽  
Bad News ◽  
Shared Decision ◽  
Communication Techniques ◽  
Relief Of Suffering ◽  
Serious Disease

ABSTRACT Introduction Palliative care is an approach aimed at relieving suffering, controlling symptoms and seeking to improve quality of life. It must be offered in conjunction with standard treatment for any disease that threatens the continuation of life, such as a Covid-19 infection. Discussion The bioethical principles and strategies used by palliative medicine can assist nephrologists in the care of patients with renal dysfunction, who face the difficulties of isolation at the beginning and follow-up of dialysis in outpatient treatment, and those who are at risk for a more serious disease progress. Some of them: - a Shared decision making, which enables the patient and family to participate as facilitators in the systematization of the team’s reasoning, in addition to respecting the principle of autonomy; - Symptom Management: which should be a priority to ensure relief of suffering even in times of social isolation; - Communication skills: making it possible to alleviate suffering in announcing bad news or complex decisions through communication techniques;; - Bereavement assistance: which in acute situations such as the pandemic, causing unexpected losses, the importance of sympathy from healthcare professionals becomes even greater. Conclusion The principles of palliative care are essential to face the challenges of a planet-wide crisis, which raises human suffering in all dimensions, and which requires the construction of strategies that can keep patients assisted, comfortable and with measures proportional to their clinical condition and preferences.

Principles of Surgical Palliative Care

2019 ◽  
pp. 13-18
Author(s):  
Anne C. Mosenthal
Keyword(s):  
Palliative Care ◽  
Quality Care ◽  
Surgical Care ◽  
Shared Decision ◽  
Life Care ◽  
Patient Centered ◽  
Serious Illness ◽  
The Core ◽  
Relief Of Suffering

The principles of surgical palliative care, an emerging field, represent the integration of surgical care and palliative care and their ethics, drawing on both disciplines to yield a more patient-centered approach to quality care. The core principle focuses on improving quality of life for those patients with serious illness and surgical disease or under the care of surgeons. Surgical palliative care addresses relief of suffering and shared decision-making across the life span, regardless of prognosis, and thus goes beyond end-of-life care and hospice. The chapter defines the principles of surgical palliative care, their ethical foundation, and their application in practice.

scholarly journals Public perception of palliative care: a survey of the general population

2021 ◽  
Vol 15 ◽  
pp. 263235242110175
Author(s):  
Monica C. Fliedner ◽  
Sofia C. Zambrano ◽  
Steffen Eychmueller
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Public Perception ◽  
Healthcare Professionals ◽  
Inductive Reasoning ◽  
Good Health ◽  
The Public ◽  
Relief Of Suffering ◽  
German Speaking

Background: The public’s view of palliative care often involves its potential to improve of quality-of-life as well as its use as a last resource prior to death. Objective: To obtain an idea of the image of palliative care held by the public in the German-speaking part of Switzerland, the authors sought to understand (1) the perceptions of palliative care and the (2) elements important when thinking about their own end of life. Methods and Sample: A qualitative design with an inductive reasoning approach based on Mayring (2014) was chosen. Visitors at an exhibition about palliative care in six locations provided hand-written answers on provided cards to two statements: (1) if I hear the term ‘Palliative Care’ I think of … and (2) when thinking about my own end of life, the following is important to me … Results: Answers of 199 visitors (mean age 52, mostly in a good/very good health status) were analysed. In response to hearing the term palliative care, six areas were categorized: (1) the main focus; (2) ways of providing palliative care; (3) the best timing; (4) places where palliative care is provided; (5) who is seen as provider and (6) outcomes of palliative care. Five categories to the statement about their own end-of-life were identified: (1) the ability to look back on a fulfilled life and being satisfied; (2) maintaining trusting relationships until the end; (3) organizing affairs and having everything settled; (4) having their family being cared for and (5) relief of suffering with the support of knowledgeable people. Conclusion: Palliative care was mostly associated with positive terms acknowledging an interprofessional approach. Maintaining one’s dignity as well as dying without suffering pointed at the persisting stigma that palliative care is mainly limited to end-of-life care. The results may help healthcare professionals to better understand how the public view palliative care.

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

scholarly journals PENGEMBANGAN KAPASITAS PEREMPUAN BAGI IBU-IBU RELAWAN PROGRAM PALIATIF DI DESA KAMBINGAN DAN DESA KREMBUNG, KECAMATAN CERME, KABUPATEN GRESIK

2020 ◽  
Vol 4 (1) ◽  
pp. 189
Author(s):  
Sulikah Asmorowati ◽  
Inge Dhamanty
Keyword(s):  
Palliative Care ◽  
High Rate ◽  
World Health ◽  
Target Area ◽  
Target Groups ◽  
Community Project ◽  
Health Organization ◽  
End Stage

The high rate of deaths caused by serious illnesses has led the World Health Organization (WHO) to recommend palliative care that is considered to be able to improve the quality of patient’s live Palliative care or service is service for patients with serious illnesses, such as cancer (stadium or end-stage). In this activity, however, palliative care and service is extended so that it includes diseases that are not contagious but deadly (thus, contributed significantly to mortality rate), including such illnesses as diabetes, high-blood pressure, cholesterol, stroke and other similar illnesses. These illnesses are now increasingly being suffered by and become the major cause of death (caused by illnesses) amongst Indonesians. In order to increase the availability of palliative services in the target area, this community project provides training and assistance to develop women’s capacity in the villages of Kambingan and Ngembung, Cerme, Gresik, so that they are ready to volunteers for palliative care and service in their respective communities. The projects were conducted by providing material through lectures, and modules; followed by assistance to form a team of palliative case and service. At the end, this project resulted in the increasing understanding, and capacity of women (and mothers or PKK member), as the target groups about palliative care and services. In turn, the women were then ready to become volunteers for palliative care and program.abstrakTingginya tingkat kematian akibat penyakit serius membuat WHO menyarankan untuk melakukan perawatan paliatif yang dianggap dapat meningkatkan kualitas hidup pasien. Program atau layanan paliatif adalah pelayanan kepada pasien dengan penyakit berat, yaitu kanker (stadium akhir). Dalam kegiatan pengabdian masyarakat (pengmas) ini, layanan paliatif diperluas sehingga meliputi pula penyakit-penyakit yang tidak menular namun mematikan, seperti penyakit diabates, darah tinggi, kolesterol, stroke dan sejenisnya yang dewasa ini semakin banyak di derita masyarakat Indonesia. Kegiatan pengmas ini memberikan pelatihan dan pendampingan untuk mengembangkan kapasitas ibu-ibu tim penggerak dan anggota PKK di Desa Kambingan dan Desa Ngembung, Kecamatan Cerme, Kabupaten Gresik agar siap untuk menjadi relawan program paliatif di lingkungan masyarakat masing-masing. Metode yang digunakan dalam kegiatan ini adalah dengan pemberian materi melalui ceramah, pemberian modul, serta pendampingan pembentukan tim paliatif sebagai follow-up kegiatan. Hasil yang dicapai dari kegiatan pengabdian masyarakat ini adalah meningkatnya pemahaman masyarakat khususnya ibu-ibu tentang layanan paliatif, serta meningkatnya kapasitas mereka,sehingga siap menjadi relawan program paliatif.

scholarly journals Reorganisation of faecal microbiota transplant services during the COVID-19 pandemic

Gut ◽  
2020 ◽  
Vol 69 (9) ◽  
pp. 1555-1563 ◽  
Author(s):  
Gianluca Ianiro ◽  
Benjamin H Mullish ◽  
Colleen R Kelly ◽  
Zain Kassam ◽  
Ed J Kuijper ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Faecal Microbiota ◽  
Clostridioides Difficile ◽  
Research Activities ◽  
Increased Risk ◽  
Recruitment And Selection ◽  
Spread Of Infection ◽  
The Impact

The COVID-19 pandemic has led to an exponential increase in SARS-CoV-2 infections and associated deaths, and represents a significant challenge to healthcare professionals and facilities. Individual countries have taken several prevention and containment actions to control the spread of infection, including measures to guarantee safety of both healthcare professionals and patients who are at increased risk of infection from COVID-19. Faecal microbiota transplantation (FMT) has a well-established role in the treatment of Clostridioides difficile infection. In the time of the pandemic, FMT centres and stool banks are required to adopt a workflow that continues to ensure reliable patient access to FMT while maintaining safety and quality of procedures. In this position paper, based on the best available evidence, worldwide FMT experts provide guidance on issues relating to the impact of COVID-19 on FMT, including patient selection, donor recruitment and selection, stool manufacturing, FMT procedures, patient follow-up and research activities.

Retrospective review of end-of-life care in the last month of life in older patients with multiple myeloma: what collaboration between haematologists and palliative care teams?

2020 ◽  
pp. bmjspcare-2020-002293
Author(s):  
Thomas Chalopin ◽  
Nicolas Vallet ◽  
Lotfi Benboubker ◽  
Marlène Ochmann ◽  
Emmanuel Gyan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Palliative Care ◽  
End Of Life ◽  
Older Patients ◽  
High Rate ◽  
Palliative Care Teams ◽  
Care Family ◽  
Eol Care

ObjectivesPatients with haematological malignancies (HM) receive more aggressive treatments near the end-of-life (EOL) than patients with solid tumours. Palliative care (PC) needs are less widely acknowledged in patients with multiple myeloma (MM) than in other HM. The main objective of our study was to describe EOL care and PC referral in a population of older patients with MM.MethodsWe retrospectively included deceased inpatients and outpatients with an MM previously diagnosed at the age of 70 and over in two tertiary centres in France. We reported EOL characteristics regarding treatments considered to be aggressive—antimyeloma therapies, hospitalisations, blood product transfusions, intensive care units (ICUs) or emergency admissions—and PC referral.ResultsWe included 119 patients. In their last month of life, 75 (63%) were hospitalised for fever, pain, asthenia, anaemia or bleeding, 49 (41%) were admitted in the emergency department and 12 (10%) in ICU, 76 (64%) still received antimyeloma therapy and 45 (38%) had at least two transfusions. Only 24 (20%) received PC intervention for pain, global care, family support, anxiety, social care or confusion. Median follow-up until death was 20 days.ConclusionsOur study found a high rate of hospitalisations and antimyeloma therapies in the last month of life. The PC referral rate was low, often once specific treatments were stopped. Our results suggest the need for more effective collaboration between PC teams and haematologists in order to respond to the specific needs of these patients and to improve their quality of care at EOL.

scholarly journals Upside down solutions: palliative care and COVID-19

2020 ◽  
pp. bmjspcare-2020-002385 ◽  
Author(s):  
Daniel Knights ◽  
Felicity Knights ◽  
Iain Lawrie
Keyword(s):  
Palliative Care ◽  
Symptom Control ◽  
Well Being ◽  
Models Of Care ◽  
Resource Limited ◽  
Relief Of Suffering ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Effective Use

The current COVID-19 pandemic is unprecedented and requires innovation beyond existing approaches to contribute to global health and well-being. This is essential to support the care of people at the end of their lives or who are critically ill from COVID-19 or other life-limiting illnesses. Palliative care (PC) is centred on effective symptom control, promotion of quality of life, complex decision-making, and holistic care of physical, psychological, social and spiritual health. It is ideally placed to both provide and contribute to care for patients, families, communities and colleagues during the pandemic. Where recovery is uncertain, emphasis should be on care and relief of suffering, as well as survival. Where healthcare resources and facilities come under intense pressure, lessons can be learnt from models of care in other settings around the world. This article explores how the field can contribute by ensuring that PC principles and practices are woven into everyday healthcare practice. We explore alternative ways of providing care under such pressure and discuss three areas of learning from resource-limited settings: (1) integration of palliative medicine into everyday practice, (2) simplification of biomedical management plus multidisciplinary teamwork and (3) effective use of volunteers.

Pulmonary lymphangitis and cancer: Prospective series of 37 patients in palliative care

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18600-18600 ◽  
Author(s):  
A. A. Dettino ◽  
E. M. Negri ◽  
T. Pagano
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Short Form ◽  
Primary Tumors ◽  
Patients With Cancer ◽  
The Moment ◽  
In The Beginning ◽  
Minor Criteria

18600 Background: Lymphangitis of the lungs is an uncommon type of metastasis, mainly in breast, lung and gastric cancers, and has major impact in quality of life and an unfavorable prognosis. Survival is very poor: 50% in 3 and 15% in 6 months. Our objective was to evaluate prospectively quality of life in cancer patients with pulmonary lymphangitis, under palliative care. Methods: Patients with pulmonary lymphangitis, diagnosed either by lung biopsy (major criteria) or 3 minor criteria (cyto or histotologically proven cancer, clinical picture and image exam) were followed in 3 tertiary services, in a cohort series study. Primary end point was quality of life (QoL), measured with questionnaires in the beginning of the study and monthly afterwards (Saint George Respiratory Questionnaire -SGRQ- and Medical Outcomes Study 36-Item Short-Form Health Survey -SF36). Clinical and complementary aspects were also followed, in addition to treatment and outcome. Results: Thirty-seven patients were included from Aug/2004 to Jan/2006 - 23 female and 14 male; age from 41 to 84 (mean: 62) years. Primary tumors were: lung (20), breast (11), esophagus (2), pancreas, rectum and bone. Of those patients, 33 were able to respond QoL questionnaires in the beginning of follow-up and monthly thereafter. Median follow-up was of one month (range: 0–13); at the moment, 9 patients are still alive. Median survival was 2.5 months (range: 0,1–33), with 38% with a survival of at least 6 months. In general, QoL was poor, but improved after palliative care. Notice that values get higher as QoL improves in SF-36; however, they get lower as QoL improves in SGRQ - values were 61.5, 50.5, 61.7, and 47.5% for SGRQ and 38.1, 32.1, 32.8, 61.6 for SF36 in 0, 1, 3 and 6 months, respectively. Palliative care included: corticosteroids (65%), oxygen (51%), opioids (51%), diuretics (47%), inhalations with beta2-agonists and/or ipatropium (57%), chemo and/or hormonotherapy (51%), physical therapy (43%), antidepressants and benzodiazepines (37% each), thoracocentesis (35%), and blood transfusions. Conclusions: Even though QoL is poor and survival is short for patients with cancer lymphangitis in lungs, some improvement is possible with active palliative care. No significant financial relationships to disclose.

Moving palliative care upstream for patients diagnosed with head and neck cancers.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 227-227
Author(s):  
Tamara M Day
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Head And Neck ◽  
Symptom Burden ◽  
Psychosocial Distress ◽  
Head And Neck Cancers ◽  
Improve Quality ◽  
Convenience Sample

227 Background: Adults with cancer face complex treatment choices and symptom burden that impact their quality of life. Goals of palliative care (PC) are to reduce symptom burden and improve quality of life. Strong evidence exists that PC helps reduce symptom burden, decreases hospital utilization, and improve quality of life. Yet, PC remains underutilized, especially in the context of cancer care. Methods: This descriptive longitudinal study evaluated whether use of a psychosocial distress screening tool would help identify patients eligible for PC. A convenience sample of adults with diagnosis of head and neck cancers presenting to an otolaryngology clinic, located in the cancer center of a Midwestern academic health system, were screened for eligibility for PC referral. If eligible, the provider was notified and introduced PC to the patient. Upon acceptance, a PC referral was ordered. The project consisted of baseline (n = 61) and follow-up chart reviews (n = 60) of patients seen in clinic during over a 3-month period. Results: We found an increase in PC referrals from 14.6% at baseline to 30.8% in follow-up, a 227% increase. Psychosocial distress screenings increased from 5% at baseline to 45% in follow-up, an increase of 200%. Of patients who received a PC referral, 85.6% accepted. There were statistically significant differences found between the pre- and post-intervention groups for marital status, χ2 (3) = 9.67, ( p = .02); and cancer stage χ2 (4) = 21.35, ( p = .00) with increased referrals for married patients at higher cancer stages in the prospective group. Conclusions: This study has shown physicians maybe more likely to offer PC referrals based on cancer stages, and not based on psychosocial distress symptoms. Potential barriers to early referral to PC were identified and could serve as useful information for future studies.

scholarly journals The Nursing Dimension of Providing Palliative Care to Children and Adolescents with Cancer

2012 ◽  
Vol 6 ◽  
pp. CMPed.S8208 ◽  
Author(s):  
Sharron L. Docherty ◽  
Cheryl Thaxton ◽  
Courtney Allison ◽  
Raymond C. Barfield ◽  
Robert F. Tamburro
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Children And Adolescents ◽  
Pediatric Oncology ◽  
Clear Understanding ◽  
Curative Therapy ◽  
Oncology Nurse ◽  
Integral Role ◽  
Relief Of Suffering

Palliative care for children and adolescents with cancer includes interventions that focus on the relief of suffering, optimization of function, and improvement of quality of life at any and all stages of disease. This care is most effectively provided by a multidisciplinary team. Nurses perform an integral role on that team by identifying symptoms, providing care coordination, and assuring clear communication. Several basic tenets appear essential to the provision of optimal palliative care. First, palliative care should be administered concurrently with curative therapy beginning at diagnosis and assuming a more significant role at end of life. This treatment approach, recommended by many medical societies, has been associated with numerous benefits including longer survival. Second, realistic, objective goals of care must be developed. A clear understanding of the prognosis by the patient, family, and all members of the medical team is essential to the development of these goals. The pediatric oncology nurse is pivotal in developing these goals and assuring that they are adhered to across all specialties. Third, effective therapies to prevent and relieve the symptoms of suffering must be provided. This can only be accomplished with accurate and repeated assessments. The pediatric oncology nurse is vital in providing these assessments and must possess a working knowledge of the most common symptoms associated with suffering. With a basic understanding of these palliative care principles and competency in the core skills required for this care, the pediatric oncology nurse will optimize quality of life for children and adolescents with cancer.

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