Putting Clinical Ethics into Guideline Format: When and how to Limit Therapeutic Interventions in Palliative Care as a Part of the German Evidenced-Based Guideline `Palliative Care for Patients with Incurable Cancer`

Objective: The primary aim of the present article was to identify palliative care patient populations who are willing to participate in and able to complete a group exercise/physical training program designed specifically for the individual patient.Method: We conducted a prospective phase II intervention study examining the willingness and ability of palliative care cancer patients to participate in a group exercise physical training program. Patients who were diagnosed with incurable cancer and had a life expectancy of less than 1 year at two outpatient clinics were invited to participate in an exercise program in the hospitals. The groups met twice a week over a 6-week period.Results: One hundred one consecutive patients were asked for inclusion. Sixty-three patients agreed to participate. Sixteen (25%) of the 63 patients dropped out after consent was given, but before the program started due to medical problems, social reasons, or death. Thus, 47 patients started the exercise program. Thirteen patients withdrew during the program due to sudden death, medical problems, or social reasons. The most frequent reasons for withdrawal were increased pain or other symptoms. Thirty-four patients completed the exercise program.Significance of results: A high proportion of incurable cancer patients were willing to participate (63%) in a structured exercise program. The attrition rate was high, but despite being severely ill, 54% of the patients completed the exercise period. This shows that a physical exercise program tailored to the individual patient is feasible in this population.

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Serving the Very Sick, Very Frail, and Very Old: Geriatrics, Palliative Care, and Clinical Ethics

Perspectives in Biology and Medicine ◽

10.1353/pbm.2017.0039 ◽

2017 ◽

Vol 60 (4) ◽

pp. 503-518

Author(s):

Alexander K. Smith ◽

Guy Micco

Keyword(s):

Palliative Care ◽

Clinical Ethics ◽

Very Old

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Preferred Place of Death for Patients With Incurable Cancer and Their Family Caregivers in Egypt

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118813990 ◽

2018 ◽

Vol 36 (5) ◽

pp. 423-428

Author(s):

Samy A. Alsirafy ◽

Ahmad M. Hammad ◽

Noha Y. Ibrahim ◽

Dina E. Farag ◽

Omar Zaki

Keyword(s):

Palliative Care ◽

Family Caregivers ◽

Full Employment ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Place Of Death ◽

Hospital Death ◽

Incurable Cancer ◽

Mediterranean Countries ◽

Egyptian Patients

Background: Little is known about the place of death of patients with cancer in Eastern Mediterranean countries including Egypt, where palliative care is underdeveloped. Identifying the preferred place of death (PPoD) is important for the development of appropriate palliative care models in these countries. Objectives: To know the PPoD of Egyptian patients with incurable cancer and their family caregivers (FCGs) and to determine the factors that may impact their preferences. Methods: An observational cross-sectional study that included 301 dyads of patients with incurable cancer and one of their FCGs. A questionnaire was designed to collect data about the characteristics of patients and FCGs as well as their preferences. Results: The majority of dyads (272/301, 90.4%) answered the PPoD question. Home was the PPoD in 93% of patients and 90.1% of FCGs ( P = .218). The congruence between patients’ and FCGs’ PPoD was 92.7% (κ = 0.526). In multivariate analysis, poorer performance status (Eastern Cooperative Oncology Group 3 or 4) and full employment of FCGs associated significantly with patients’ preference to die in hospital (odds ratio [OR] = 3.015 [95% confidence interval [CI]: 1.004-9.054], P = .049 and OR = 4.402 [95% CI: 1.561-12.417], P = .005, respectively), while poorer performance status and nonreferral to the palliative medicine unit were associated with FCGs’ preference of hospital death (OR = 2.705 [95% CI: 1.105-6.626], P = .029 and OR = 2.537 [95% CI: 1.082-5.948], P = .032, respectively). Conclusions: The results of the current study suggest that home is the PPoD for the vast majority of Egyptian patients with incurable cancer and their FCGs. Palliative care interventions that promote home death of patients with incurable cancer are needed in Egypt.

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Applied physiotherapeutic and occupational therapeutic interventions within palliative care: an exploratory survey

Progress in Palliative Care ◽

10.1080/09699260.2019.1632509 ◽

2019 ◽

Vol 27 (3) ◽

pp. 109-116 ◽

Cited By ~ 2

Author(s):

Bert Leysen ◽

Arne Van Daele ◽

Tom Verrept ◽

Wim Saeys

Keyword(s):

Palliative Care ◽

Therapeutic Interventions ◽

Exploratory Survey

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Older people with incurable cancer: Existential meaning-making from a life-span perspective

Palliative & Supportive Care ◽

10.1017/s1478951515000644 ◽

2015 ◽

Vol 14 (1) ◽

pp. 20-32 ◽

Cited By ~ 7

Author(s):

Sigrid Helene Kjørven Haug ◽

Lars J. Danbolt ◽

Kari Kvigne ◽

Valerie DeMarinis

Keyword(s):

Palliative Care ◽

Older People ◽

Life Span ◽

Daily Living ◽

Developmental Psychology ◽

Meaning Making ◽

Adaptive Strategies ◽

Growth Potential ◽

Incurable Cancer ◽

Existential Meaning

ABSTRACTObjective:An increasing number of older people in Western countries are living with incurable cancer, receiving palliative care from specialized healthcare contexts. The aim of our article was to understand how they experience the existential meaning-making function in daily living from a life-span perspective.Method:Some 21 participants (12 men and 9 women), aged 70–88, were interviewed in a semistructured framework. They were recruited from somatic hospitals in southeastern Norway. We applied the model of selective optimization with compensation (SOC) from life-span developmental psychology in a deductive manner to explore the participants' life-oriented adaptive strategies. A meaning component was added to the SOC model.Results:The participants experienced the existential meaning-making function on two levels. On a superordinate level, it was an important component for interpreting and coordinating the adaptive strategies of SOC for reaching the most important goals in daily living. The existential meaning-making framework provided for a comprehensive understanding of resilience, allowing for both restoration and growth components to be identified. The second level was related to strategy, in that the existential meaning-making function was involved in a complex interaction with behavioral resources and resilience, leading to continuation of goals and more realistic goal adjustments. A few experienced existential meaning-making dysfunction.Significance of results:The modified SOC model was seen as applicable for palliative care in specialized healthcare contexts. Employing the existential meaning-making framework with its complementary understanding of resilience as growth potential to the SOC model's restoration potential can help older people to identify how they make meaning and how this influences their adaptation process to being incurably sick.

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Don’t become a burden and don’t complain: a case study of older persons suffering from incurable cancer and living alone in rural areas

Nursing Reports ◽

10.4081/nursrep.2011.e3 ◽

2011 ◽

Vol 1 (1) ◽

pp. 3 ◽

Cited By ~ 3

Author(s):

Guri Bitnes Wiik ◽

Siri Devik ◽

Ove Hellzen

Keyword(s):

Palliative Care ◽

Older People ◽

Rural Areas ◽

Urban Areas ◽

Older Persons ◽

Healthcare Services ◽

Hospital Treatment ◽

Incurable Cancer ◽

Gain Access

The majority of older people wish to continue to live at home for as long as possible. As a consequence, the healthcare system, including cancer care, is located in urban areas and people living in rural areas must commute to gain access to the services offered. The aim of this study was to investigate how older people, who live on their own, experience living with incurable cancer and commuting for palliative care in rural Norway. A case study was designed and informants were recruited not because they were typical but because they were deemed to have the potential to contribute to knowledge about the phenomenon of being an older person who has been diagnosed with incurable cancer and lives alone in a rural area. Three major categories were identified: “Hovering between hope and fear, Stressful commuting to palliative care, and Being exhausted. The findings indicated that older people who have been stricken with incurable cancer and who live alone in rural areas have to walk the palliative path alone. A common feature of all the informants is that they do not speak out and they do not complain. Even though the trend in healthcare is towards centralized treatment, shorter and more effective stays in hospital, and policlinic (policlinic services are a place where healthcare services can be accessed without the need for an overnight stay in hospital, usually such clinics are located close to a hospital) treatment and care, not all older persons manage to take care of themselves. The findings suggest that nurses should pay more attention to these patients’ needs for care at different levels of the healthcare service.

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