scholarly journals End-of-Life Cancer Care Resource Utilisation in Rural Versus Urban Settings: A Systematic Review

2020 ◽  
Vol 17 (14) ◽  
pp. 4955
Author(s):  
Jessica Cerni ◽  
Joel Rhee ◽  
Hassan Hosseinzadeh
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Cancer Care ◽  
Service Use ◽  
Care Service ◽  
Resource Utilisation ◽  
Original Research ◽  
Service Utilisation ◽  
Inclusion Criteria ◽  
Urban Rural

Background: Despite the advances in End-of-life (EOL) cancer care, disparities remain in the accessibility and utilisation of EOL cancer care resources. Often explained by socio-demographic factors, geographic variation exists in the availability and provision of EOL cancer care services among EOL cancer decedents across urban versus rural settings. This systematic review aims to synthesise mortality follow-back studies on the patterns of EOL cancer care resource use for adults (>18 years) during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English language; d) palliative care related service use in adults (>18 years) with any malignancy excluding non-melanoma skin cancers; e) exclusive end of life focus; f) urban-rural focus. Narrative reviews and discussions were excluded. Results: 24 studies met the inclusion criteria. End-of-life cancer care service utilisation patterns varied by rurality and treatment intent. Rurality was strongly associated with higher rates of Emergency Department (ED) visits and hospitalisations and lower rates of hospice care. The largest inequities between urban and rural health service utilisation patterns were explained by individual level factors including age, gender, proximity to service and survival time from cancer diagnosis. Conclusions: Rurality is an important predictor for poorer outcomes in end-of-life cancer care. Findings suggest that addressing the disparities in the urban-rural continuum is critical for efficient and equitable palliative cancer care. Further research is needed to understand barriers to service access and usage to achieve optimal EOL care for all cancer patient populations.

End-of-life palliative care resource utilization in cancer care: A focus on the urban-rural continuum.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 52-52
Author(s):  
Jessica Cerni ◽  
Joel Rhee ◽  
Hassan Hosseinzadeh
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Care ◽  
Service Use ◽  
Inclusion Criteria ◽  
Care Services ◽  
Quantitative Studies ◽  
Palliative Care Services ◽  
Urban Rural ◽  
Ed Visits

52 Background: Despite the advances in end-of-life cancer care, disparities exist in the availability, accessibility and use of palliative care services across the urban-rural continuum. This review explores this disparity by synthesising retrospective quantitative studies on palliative care patterns of resource use for adults during end-of-life cancer care. Methods: Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English-language; d) study assessed palliative care related service use in adult (18yrs+) cancer patients with any malignancy excluding non-melanoma skin cancer; e) exclusive end of life focus and f) urban-rural focus. Narrative reviews and discussions were excluded. Results: After reviewing all titles and abstracts ( N= 816) and full text review ( N= 163) 44 studies met the inclusion criteria and were included in the analysis. End-of-life palliative care access and utilisation patterns varied across the geographical urban-rural continuum. Geographical region of residence had the strongest association with multiple ED visits and hospitalizations in rural or remote areas. Most common palliative care services used within the last 30 days of death were ED visits and hospital admissions. Two studies assessed palliative radiotherapy and one study assessed palliative care pharmacotherapy. The odds of palliative service use were lowest for males and individuals with a survival diagnosis (0-3months). The largest inequities were explained by individual level factors including gender as assessed in ( N= 44 studies), socioeconomic status ( N= 15), proximity to service ( N= 10) and survival time from cancer diagnosis ( N= 9). Conclusions: Rurality was an important predictor for poorer outcomes in the quality of end-of-life cancer care. Findings suggest that addressing the urban-rural continuum is critical for equitable, timely and efficient palliative cancer care. Further research is required to understand barriers to service usage to achieve optimal palliative care.

scholarly journals Defining end of life in dementia: A systematic review

2021 ◽  
pp. 026921632110254
Author(s):  
Bria Browne ◽  
Nuriye Kupeli ◽  
Kirsten J Moore ◽  
Elizabeth L Sampson ◽  
Nathan Davies
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Healthcare Professionals ◽  
Functional Decline ◽  
Advanced Stage ◽  
Family Carers ◽  
Inclusion Criteria ◽  
Single Measure ◽  
People With Dementia ◽  
Limiting Condition

Background: Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia. Aim: To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia. Design: Systematic review and narrative synthesis. Data Sources: Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia. Results: Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life. Conclusion: End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.

scholarly journals End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

2017 ◽  
Vol 32 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Caroline Shulman ◽  
Briony F Hudson ◽  
Joseph Low ◽  
Nigel Hewett ◽  
Julian Daley ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Service Use ◽  
Social Care ◽  
Care Service ◽  
Homeless People ◽  
Palliative Care Service ◽  
Care Providers ◽  
Health And Social Care ◽  
Formerly Homeless

Background: Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited. Aim: To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care. Design: Thematic analysis of data collected using focus groups and interviews. Participants: Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10). Results: This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues. Conclusion: Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.

scholarly journals OP35 A systematic review of population-based quality indicators for end of life cancer care

2019 ◽  
Author(s):  
LA Henson ◽  
P Edmonds ◽  
H Johnson ◽  
A Johnston ◽  
CNY Ling ◽  
...  
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Quality Indicators ◽  
Cancer Care ◽  
Population Based

scholarly journals Adjuvant chemotherapy for early female breast cancer: A systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline

2014 ◽  
Vol 22 ◽  
pp. 82 ◽  
Author(s):  
S. Gandhi ◽  
G.G. Fletcher ◽  
A. Eisen ◽  
M. Mates ◽  
O.C. Freedman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Endocrine Therapy ◽  
Early Breast Cancer ◽  
Systemic Therapy ◽  
Cancer Care ◽  
Cytotoxic Chemotherapy ◽  
Evidence Based ◽  
Inclusion Criteria ◽  
Meta Analyses

BackgroundThe Program in Evidence-Based Care (PEBC) of Cancer Care Ontario (CCO) has recently created an evidence-based consensus guideline on the systemic treatment of early breast cancer.  The evidence for this guideline was compiled using a systematic review to answer the question:  “What is the optimal systemic therapy for patients with early-stage, operable breast cancer, when patient and disease factors are considered?”  This question was addressed in three parts: cytotoxic chemotherapy, endocrine treatment, and human epidermal growth factor receptor 2 (HER2) directed therapy.MethodsA systematic review was performed using the MEDLINE and EMBASE databases for the period January 2008 to May 2014.  The SAGE Directory of Cancer Guidelines and websites of major oncology guideline organizations were also searched.  The basic search terms were “breast cancer” and “systemic therapy” (chemotherapy, endocrine therapy, targeted agents, ovarian suppression), and was limited to randomized controlled trials (RCTs), guidelines, systematic reviews, and meta-analyses. ResultsSeveral hundred documents were retrieved that met the inclusion criteria; the Early Breast Cancer Trialists Collaborative Group (EBCTCG) meta-analyses encompassed many of the RCTs found. Several additional studies which met the inclusion criteria were included, as well as other guidelines and systematic reviews.  Chemotherapy was largely reviewed as three classes of agents: anti-metabolite based regimens (e.g., CMF), anthracyclines, and taxane-based regimens. Single-agent chemotherapy in general is not recommended for the adjuvant treatment of breast cancer in any patient population.  Anthracycline and taxane-based polychemotherapy regimens are overall considered superior to earlier generation regimens, with the most significant impact on patient survival outcomes. Various regimens with disparate anthracycline and taxane doses and schedules are options; in general, paclitaxel given every 3 weeks is inferior. Evidence does not support the use of bevacizumab in the adjuvant setting; other systemic therapy agents such as metformin and vaccines remain under investigation. Adjuvant bisphosphonates for menopausal women will be discussed in later work.  ConclusionThe results of this systematic review represent a comprehensive compilation of high-level evidence which was the basis for the 2014 PEBC CCO guideline on systemic therapy for early breast cancer. The use of cytotoxic chemotherapy is presented here; the results addressing endocrine therapy and HER-2 targeted treatment, as well as the final clinical practice recommendations, are published separately in this issue.

scholarly journals Sarcopenic is associated with hypertension in older adults: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Tingting Bai ◽  
Fang Fang ◽  
Feika Li ◽  
Yan Ren ◽  
Jiaan Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Confidence Interval ◽  
Handgrip Strength ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Original Research ◽  
Inclusion Criteria ◽  
Asian Group ◽  
Research Studies

Abstract BackgroundBoth sarcopenia and handgrip strength have been observed association with hypertension. However, the results in different studies were inconsistent. In the current study, we conducted a systematic review and meta-analysis to reveal the association between sarcopenia, handgrip strength, and hypertension in older adults.MethodsPubMed, MEDLINE, Cochrane Library, and EMBASE databases were searched from inception to 15 November, 2019for original research studies. The studies that addressed the association between sarcopenia, handgrip strength, and hypertension were included and summarized.Results19 studies met the inclusion criteria and a total of 21301 were included in the meta-analysis. Eight eligible studiesreported the odd ratios (ORs) of hypertension and the ORs ranged from 0.41 to 4.38. When pooled the ORs together, the summarized ORs was 1.29 [95% confidence interval (CI) =1.00-1.67]. The summarized ORs for the Asian group 1.50 (95% CI=1.35-1.67) was significantly higher than that of Caucasian group 1.08 (95% CI=0.39-2.97). Eleven studies provided the data on association between handgrip strength and hypertension. The overall ORs and 95% CI was 0.99 (95% CI=0.80-1.23), showing no association.ConclusionSarcopenia was associated with hypertension but no correlation was found between handgrip strength and hypertension in older adults.

scholarly journals Trends and Determinants of Antenatal Care Service Use in Ethiopia between 2000 and 2016

2019 ◽  
Vol 16 (5) ◽  
pp. 748 ◽  
Author(s):  
Tensae Mekonnen ◽  
Tinashe Dune ◽  
Janette Perz ◽  
Felix Akpojene Ogbo
Keyword(s):  
Antenatal Care ◽  
Service Use ◽  
Care Service ◽  
Household Wealth ◽  
Service Utilisation ◽  
Wealth Status ◽  
Sampling Weights ◽  
Logistic Regression Models ◽  
Health Survey Data ◽  
And Child Health

: Antenatal care (ANC) services are an essential intervention for improving maternal and child health worldwide. In Ethiopia, however, ANC service use has been suboptimal, and examining the trends and factors associated with ANC service use is needed to inform targeted maternal health care interventions. This study aimed to investigate the trends and determinants of ANC service utilisation in Ethiopia for the period ranging from 2000 to 2016. This study draws on the Ethiopia Demographic and Health Survey data for the years 2000 (n = 7928), 2005 (n = 7276), 2011 (n = 7881) and 2016 (n = 7558) to estimate the trends in ANC service utilisation. Multivariate logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the study factors and ANC service utilisation. Over the sixteen-year period, the proportion of Ethiopian women who received the recommended four or more ANC visits increased from 10.0% (95% confidence interval (95% CI: 8.7–12.5%) in 2000 to 32.0% (95% CI: 29.4–34.3%) in 2016. Similarly, the proportion of women who received one to three ANC visits increased from 27.0% (95% CI: 23.6–30.7%) in 2000 to 62.0% in 2016 (95% CI: 60.4–67.3%). Multivariate analyses showed that higher maternal and paternal education, higher household wealth status, urban residency and previous use of a contraceptive were associated with ANC service use (1–3 and 4+ ANC visits). The study suggests that while Ethiopian pregnant women’s engagement with ANC services improved during the millennium development goal era (2000–2015), recommended ANC use remains suboptimal. Improving the utilisation of ANC services among pregnant women is essential in Ethiopia, and efforts should focus on vulnerable women.

Methods for overcoming barriers in palliative care for ethnic/racial minorities: a systematic review

2019 ◽  
Vol 17 (6) ◽  
pp. 697-706 ◽  
Author(s):  
Donna P. Mayeda ◽  
Katherine T. Ward
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Racial Minorities ◽  
Treatment Preferences ◽  
Original Research ◽  
Advanced Directives ◽  
Target Populations

AbstractObjectivesEthnic/racial minority groups are less likely to discuss issues involving end-of-life treatment preferences and utilize palliative care or hospice services. Some barriers may be differences in language, religion, lower levels of health literacy, or less access to healthcare services and information. The purpose of this article is to conduct a systematic review on interventional studies that investigated methods to overcome the barriers faced by ethnic/racial minorities when accessing end-of-life services, including completing advanced directives, accepting palliative care, and enrolling in hospice.MethodsLiterature searches using four standard scientific search engines were conducted to retrieve articles detailing original research in an interventional trial design. All studies were conducted in an outpatient setting, including primary care visits, home visits, and dialysis centers. Target populations were those identified from ethnic or racial minorities.ResultsNine articles were selected to be included in the final review. All were full-text English language articles, with target populations including African Americans, Hispanic or Latinos, and Asian or Pacific Islanders. Measured outcomes involved level of comfort in discussing and knowledge of palliative care services, desire for aggressive care at the end-of-life, completion of advance directives, and rate of enrollment in hospice.Significance of ResultsThree main avenues of interventions included methods to enhance patient education, increase access to healthcare, or improve communication to establish better rapport with target population. Studies indicate that traditional delivery of healthcare services may be insufficient to recruit patients from ethnic/racial minorities, and outcomes can be improved by implementing tailored interventions to overcome barriers.

Dysphagia Symptoms and Treatment in Huntington's Disease: Review

2012 ◽  
Vol 21 (4) ◽  
pp. 126-134 ◽  
Author(s):  
Celia Stewart
Keyword(s):  
Systematic Review ◽  
Huntington's Disease ◽  
Huntington’S Disease ◽  
Aspiration Pneumonia ◽  
Causes Of Death ◽  
Original Research ◽  
Inclusion Criteria ◽  
Review Articles ◽  
Common Causes ◽  
Random Control

The most common causes of death in individuals with Huntington's disease (HD) are aspiration pneumonia and choking on food. The goal of this systematic review is to describe the scope of dysphagia symptoms and current treatments for individuals with HD. This review includes studies that met the following criteria: original research, presentation of swallowing symptoms and/or treatment, and availability in print and in English. Nine research studies and two review articles met the inclusion criteria. No random control or nonrandom studies were found. Dysphagia symptoms were reported in all phases of the swallow.

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