Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes.

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The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review

Dementia ◽

10.1177/14713012211012606 ◽

2021 ◽

pp. 147130122110126

Author(s):

Alexandra E Harper ◽

Lauren Terhorst ◽

Marybeth Moscirella ◽

Rose L Turner ◽

Catherine V Piersol ◽

...

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Home Care ◽

Scoping Review ◽

Informal Caregivers ◽

Nursing Home Care ◽

Person Centered Care ◽

People With Dementia ◽

Centered Care

Background Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. Methods In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. Results We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. Conclusion Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.

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Immune Thrombocytopenia

Hematology ◽

10.1182/asheducation.v2010.1.377.3643150 ◽

2010 ◽

Vol 2010 (1) ◽

pp. 377-384 ◽

Cited By ~ 1

Author(s):

Adam Cuker ◽

Douglas B. Cines

Keyword(s):

Immune Thrombocytopenia ◽

Therapeutic Decision ◽

Platelet Destruction ◽

Aggressive Therapy ◽

Pulse Dose ◽

Thrombopoietin Receptor ◽

History Of ◽

Associated Conditions ◽

Therapeutic Decision Making

Abstract Immune thrombocytopenia (ITP) comprises a heterogeneous group of disorders characterized by autoimmune-mediated platelet destruction and impairment of thrombopoiesis. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or secondary to a growing list of associated conditions (secondary ITP), and must be differentiated from other causes of thrombocytopenia. This review focuses on primary ITP in adults. The traditional goal of therapy in this population is to achieve a hemostatic platelet count of 30 × 109/L or above for most patients while minimizing treatment-related morbidity. This approach has been called into question by the recent advent of well-tolerated and effective agents for the management of ITP, including pulse-dose dexamethasone, rituximab, and the thrombopoietin receptor agonists. Recent studies suggest the potential for aggressive therapy at the time of diagnosis to alter the natural history of ITP and point to the importance of quality-of-life considerations in therapeutic decision making.

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68Ga‐PSMA‐11 PET‐CT study in prostate cancer patients with biochemical recurrence and non‐contributive 18F‐Choline PET‐CT: Impact on therapeutic decision‐making and biomarker changes

The Prostate ◽

10.1002/pros.23751 ◽

2018 ◽

Vol 79 (5) ◽

pp. 454-461 ◽

Cited By ~ 7

Author(s):

Matthieu Barbaud ◽

Mathieu Frindel ◽

Ludovic Ferrer ◽

Maelle Le Thiec ◽

Daniela Rusu ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Cancer Patients ◽

Biochemical Recurrence ◽

Therapeutic Decision ◽

Choline Pet ◽

Pet Ct ◽

Therapeutic Decision Making

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Caring for older cancer patients: A scoping review

Health Policy ◽

10.1016/j.healthpol.2020.05.002 ◽

2020 ◽

Vol 124 (9) ◽

pp. 1008-1016

Author(s):

Fatou Bagayogo ◽

Mélanie Le Berre ◽

Christian Ruchon ◽

Jean-Louis Denis ◽

Lise Lamothe ◽

...

Keyword(s):

Cancer Patients ◽

Scoping Review ◽

Older Cancer Patients

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Immune Thrombocytopenia

Hematology ◽

10.1182/asheducation-2010.1.377 ◽

2010 ◽

Vol 2010 (1) ◽

pp. 377-384 ◽

Cited By ~ 43

Author(s):

Adam Cuker ◽

Douglas B. Cines

Keyword(s):

Immune Thrombocytopenia ◽

Therapeutic Decision ◽

Platelet Destruction ◽

Aggressive Therapy ◽

Pulse Dose ◽

Thrombopoietin Receptor ◽

History Of ◽

Associated Conditions ◽

Therapeutic Decision Making

Immune thrombocytopenia (ITP) comprises a heterogeneous group of disorders characterized by autoimmune-mediated platelet destruction and impairment of thrombopoiesis. ITP may occur in the absence of an evident predisposing etiology (primary ITP) or secondary to a growing list of associated conditions (secondary ITP), and must be differentiated from other causes of thrombocytopenia. This review focuses on primary ITP in adults. The traditional goal of therapy in this population is to achieve a hemostatic platelet count of 30 × 109/L or above for most patients while minimizing treatment-related morbidity. This approach has been called into question by the recent advent of well-tolerated and effective agents for the management of ITP, including pulse-dose dexamethasone, rituximab, and the thrombopoietin receptor agonists. Recent studies suggest the potential for aggressive therapy at the time of diagnosis to alter the natural history of ITP and point to the importance of quality-of-life considerations in therapeutic decision making.

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A systematic review of the use and validation of health-related quality of life instruments in older cancer patients

European Journal of Cancer ◽

10.1016/j.ejca.2008.07.036 ◽

2009 ◽

Vol 45 (1) ◽

pp. 19-32 ◽

Cited By ~ 37

Author(s):

Deborah Fitzsimmons ◽

Jacqueline Gilbert ◽

Frances Howse ◽

Teresa Young ◽

Juan-Ignacio Arrarras ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Cancer Patients ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Older Cancer Patients ◽

Quality Of Life Instruments

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Quality of life as a predictor of early death in older cancer patients: A prospective cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.15_suppl.e22017 ◽

2018 ◽

Vol 36 (15_suppl) ◽

pp. e22017-e22017 ◽

Cited By ~ 1

Author(s):

Jurema Telles O Lima ◽

Luiz Claudio Santos Thuler ◽

Anke Bergmann ◽

Barbara laffayette viana da Luz ◽

Maria Julia Gonçalves Mello

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Cancer Patients ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Early Death ◽

Older Cancer Patients

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Effect of Chocolate on Older Cancer Patients in Palliative Care: A Randomised Controlled Study

10.21203/rs.3.rs-548192/v1 ◽

2021 ◽

Author(s):

Josiane C. Vettori ◽

Luanda G. da-Silva ◽

Karina Pfrimer ◽

Jordão-Junior Alceu A ◽

Paulo Louzada-Junior ◽

...

Keyword(s):

Quality Of Life ◽

Oxidative Stress ◽

Palliative Care ◽

Body Composition ◽

Nutritional Status ◽

Cancer Patients ◽

Controlled Study ◽

European Organization ◽

Older Cancer Patients

Abstract Background Older advanced stage cancer patients, with changes in metabolic and nutritional status, represent an important demand for palliative care. The objective of the present study was to determine the effects of 4 weeks of chocolate consumption on the nutritional status, quality of life, body composition, oxidative stress and inflammaory activity of older cancer patients in palliative care. Methods Older cancer patients in palliative care with ambulatory monitoring were randomized to the following groups: control (CG, n = 15), intervention with 55% cocoa chocolate (IG1, n = 16) and intervention with white chocolate (IG2, n = 15) groups and evaluated before and after 4 weeks of treatment for nutritional status, food consumption, anthropometry, body composition, and laboratory parameters, and quality of life using the instrument of the European Organization for the Research and Treatment of Cancer. Results IG1 progressed with increased screening (p < 0.01) and nutritional (p = 0.04) scores on the Mini Nutritional Assessment tool. Anthropometry and body composition did not change. Regarding antioxidant capacity, reduced glutathione levels increased in IG2 (p = 0.04) and were higher than in IG1 (p < 0.01). Malondealdehyde levels were reduced in IG2 (p = 0.02) at the end of the study. Regarding quality of life, functionality improved in IG1, with a higher score in the functional domain (p = 0.03), and in the role functioning (p < 0.01) and in the social (p < 0.01) subdomains. Conclusions The consumption of chocolate with a greater cocoa content may contribute to the improvement of nutritional status and functionality among older cancer patients in palliative care. The consumption of white chocolate was associated with improved oxidative stress. Trial registration: ClinicalTrials.gov NCT04367493 - April 29, 2020. Retrospectively registered.

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