Palliative Care Needs among Patients with Advanced Illnesses in Bhutan

Abstract Background: Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. Methods: This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. Results: Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. Conclusions: The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.

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Palliative Care Needs among Patients with Advanced Illnesses in Bhutan

10.21203/rs.3.rs-63080/v3 ◽

2020 ◽

Author(s):

Tara Devi Laabar ◽

Christobel Saunders ◽

Kirsten Auret ◽

Claire E Johnson

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Developed Countries ◽

World Health ◽

Small Community ◽

Care Model ◽

Care Needs ◽

Quality Of Life Scale

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Palliative care needs among patients with advanced illnesses in Bhutan

BMC Palliative Care ◽

10.1186/s12904-020-00697-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Tara Devi Laabar ◽

Christobel Saunders ◽

Kirsten Auret ◽

Claire E. Johnson

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Developed Countries ◽

World Health ◽

Small Community ◽

Care Model ◽

Care Needs ◽

Quality Of Life Scale

Abstract Background Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. Methods This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. Results Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. Conclusions The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.

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Palliative Care Needs among Patients with Advanced Illnesses in Bhutan

10.21203/rs.3.rs-63080/v1 ◽

2020 ◽

Author(s):

Tara Devi Laabar ◽

Christobel Saunders ◽

Kirsten Auret ◽

Claire E Johnson

Keyword(s):

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Developed Countries ◽

World Health ◽

Small Community ◽

Care Model ◽

Care Needs ◽

Quality Of Life Scale

Abstract Background Palliative care improves the quality of lives of patients and families affected by life-limiting illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country.Methods This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants.Results Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease.Conclusions The symptom burden experienced by patients affected by terminal and advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.

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Quality of life for Palestinian patients with cancer in the absence of a palliative-care service: a triangulated study

The Lancet ◽

10.1016/s0140-6736(13)62595-7 ◽

2013 ◽

Vol 382 ◽

pp. S23 ◽

Cited By ~ 6

Author(s):

Mohamad H Khleif ◽

Asma M Imam

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Care Service ◽

Palliative Care Service ◽

Patients With Cancer

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The Relationship among a Palliative Care Service, Patient’s Factors, and Quality of Life of Post Treatment Cervical Cancer Patients: a Causal Model Approach

Siriraj Medical Journal ◽

10.33192/smj.2019.41 ◽

2019 ◽

Vol 71 (4) ◽

pp. 268-277

Author(s):

Ketsarin Utriyaprasit

Keyword(s):

Quality Of Life ◽

Cervical Cancer ◽

Palliative Care ◽

Cancer Patients ◽

Causal Model ◽

Care Service ◽

Palliative Care Service ◽

The Relationship ◽

Model Approach

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Adaptations to palliative home care in India in a COVID pandemic: An experiential narrative

Indian Journal of Medical Sciences ◽

10.25259/ijms_13_2021 ◽

2021 ◽

Vol 73 ◽

pp. 48-51

Author(s):

Sunil Rameshchandra Dhiliwal ◽

Ashish Gulia ◽

Naveen Salins

Keyword(s):

Palliative Care ◽

Service Delivery ◽

Care Service ◽

Palliative Care Service ◽

Personal Protection ◽

Care Needs ◽

Personal Protection Equipment ◽

Complex Needs ◽

Care Access ◽

Home Based

India is in the midst of a fierce pandemic with a rapid surge of cases and the health-care system in a quandary. Care of patients with life-limiting illness needing palliative care has been compromised due to limitations in palliative care access and a paradigm shift in the hospital toward care of COVID. Therefore, it is imperative to augment the home-based services so that patients continue to remain at home with their care needs met so that their access to hospitals is restricted for acute and complex needs. To overcome practical aspects of home-based care service delivery, several adaptations were needed. An urban standalone home-based palliative care service provider made adaptations to personal protection, personal protection equipment, and team self-care that facilitated an effective service delivery and satisfaction.

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Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study

Palliative Medicine ◽

10.1177/0269216317727158 ◽

2017 ◽

Vol 32 (1) ◽

pp. 114-122 ◽

Cited By ~ 17

Author(s):

Sigrid Dierickx ◽

Luc Deliens ◽

Joachim Cohen ◽

Kenneth Chambaere

Keyword(s):

Palliative Care ◽

Odds Ratio ◽

Care Service ◽

Palliative Care Service ◽

Population Based ◽

Decision Making Process ◽

Care Needs ◽

International Debate ◽

Care Services ◽

Palliative Care Services

Background: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. Aim: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. Design: Population-based mortality follow-back survey. Setting/participants: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. Results: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5–2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient’s palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). Conclusion: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.

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A retrospective review of patients with hematological malignancy referred to an inpatient palliative care service in a tertiary hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.117 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 117-117

Author(s):

Yee Choon Meng ◽

Mervyn Yong Hwang Koh ◽

Zi Yan Chiam ◽

Jun Jun Zhang ◽

Yin Mei, Allyn Hum

Keyword(s):

Palliative Care ◽

End Of Life ◽

Retrospective Review ◽

Hematological Malignancies ◽

Hematological Malignancy ◽

Care Service ◽

Symptom Control ◽

Palliative Care Service ◽

Solid Organ ◽

Care Needs

117 Background: Patients with hematological malignancies are referred to palliative care service later and less often than patients with solid organ tumor. However, there are no data in Singapore, on the referral pattern among patients with hematological malignancy. The objective of the study is to identify the characteristics and outcomes of patients with hematological malignancy referred to an In-patient Palliative Care Service (PCS). Methods: We performed a retrospective review of all patients with hematological malignancies referred to the in-patient PCS from December 2015 to December 2016. Basic demographics and outcomes of patients’ admission were collected as per protocol. Results: 53 patients were included in the study. 27 (50.9%) patients were male, 49 (92.5%) were ≥60 years old, 20 (37.7%) were receiving cancer treatment at the point of referral, and 24 (45.3%) had Palliative Performance Scale (PPS) ≤ 40%. The most common hematological diagnosis was lymphoma (N = 26, 49.1%). The top 3 reasons for referral were symptom management (N = 44; 83%), advance disease (N = 24; 45.3% and end-of-life discussion (N = 15, 28.3%). Among 44 patients referred for symptom control, 18 (40.9%) had pain, 12 (27.3%) had dyspnoea, 8 (18.2%) had confusion and 6 (13.6%) had fatigue or drowsiness. 30 patients (56.6%) died during the admission. Among 30 patients who died, the mean time from referral to death was 9.8 days; 16 (53.3%) died within 1 week from referral, 9 (30%) died between 1-4 weeks from referral and 5 (16.7%) died beyond 4 weeks after referral.5 patients (9.4%) had Advance Care Planning completed. Conclusions: Our review showed that patients with hematological malignancies are referred late in their disease trajectory and have high Palliative Care needs. Hence, collaborative effort to facilitate timely referral of patients with hematological malignancy to PCS will optimize end-of-life care.

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A Formal Palliative Care Service Improves the Quality of Care in Patients with Stage IV Cancer and Bowel Obstruction

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909115603960 ◽

2016 ◽

Vol 34 (1) ◽

pp. 20-25 ◽

Cited By ~ 2

Author(s):

Emmanuel Gabriel ◽

Moshim Kukar ◽

Adrienne Groman ◽

Amy Alvarez-Perez ◽

Jaclyn Schneider ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Bowel Obstruction ◽

Care Service ◽

Palliative Care Service ◽

Stage Iv ◽

Management Problem ◽

Do Not Resuscitate ◽

Stage Iv Cancer

Background: Patients with stage IV cancer and bowel obstruction present a complicated management problem. The aim of this study was to evaluate the role of the palliative care service (PC) in the management of this complex disease process. Methods: A retrospective analysis was conducted of all patients admitted to Roswell Park Cancer Institute with stage IV cancer and bowel obstruction from 2009 to 2012 after the institution of a formal PC. This cohort was matched to similar patients from 2005 to 2008 (no palliative care service or NPC). Patient characteristics and outcomes included baseline demographics, comorbid conditions, do-not-resuscitate (DNR) status, laboratory parameters, medical and surgical management, length of stay, symptom relief, and disposition status. Results: A total of 19 patients were identified in the PC group. Based on the PC group baseline characteristics, 19 patients were identified for the NPC group using matched values. Regarding outcomes, there were significant differences in the medication regimens (narcotics, octreotide, and Decadron) between the 2 groups. In the PC group, 14 of 19 patients showed improvement compared to 9 of 19 in the NPC group. Nearly 60% of patients in the PC group had a formal DNR order versus 10.5% in NPC ( P = .002). A significantly higher percentage of patients were discharged to hospice in the PC group (47.4% vs 0.0%, P = .006). Conclusion: Palliative care consultation improves the quality of care for patients with stage IV cancer and bowel obstruction, with particular benefits in symptom management, end-of-life discussion, and disposition to hospice.

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