scholarly journals Patient–physician discordance in goals of care for patients with advanced cancer

2019 ◽  
Vol 26 (6) ◽  
Author(s):  
S. L. Douglas ◽  
B. J. Daly ◽  
N. J. Meropol ◽  
A. R. Lipson
Keyword(s):  
Quality Of Life ◽  
Visual Analog Scale ◽  
Metastatic Cancer ◽  
Absolute Difference ◽  
Analog Scale ◽  
Goals Of Care ◽  
Delivery Of Care ◽  
Patient Goals ◽  
Length Of Life

Background Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance.Methods Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more.Results The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance (p = 0.049; φ = 0.20).Conclusions The data indicate the presence of significant ongoing oncologist–patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient’s goals and lead to delivery of care that is aligned with patient goals.

scholarly journals DISCORDANCE IN GOALS OF CARE BETWEEN PATIENTS WITH ADVANCED CANCER AND THEIR CAREGIVERS: DOES AGE PLAY A ROLE?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Amy R Lipson ◽  
Sara Douglas
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Visual Analog Scale ◽  
Treatment Decisions ◽  
Analog Scale ◽  
Goals Of Care ◽  
The Impact

Abstract Cancer is considered a family disease as the caregivers (CG’s) role extends beyond providing care as they can also help facilitate treatment decisions. While much has been reported in the literature about patient (PT) goals of care (GoC), little is known about discordance between PT and CG GoC and the impact of PT age. The variables of interest were PT and CG identified GoC using a 100-point visual analog scale (VAS) with anchors of quality of life (0) and survival (100). Discordance was defined as a > 40 point difference on the VAS. The GoC data reported here were those obtained at enrollment and prior to subject’s death. A sample of 235 PTs and CGs of PTs diagnosed with advanced cancers were included in the study. Mean age for the PTs was 64.7 (SD=10.5, range =21-88) with 54% being > 65. At enrollment, 28.7% of the PT-CG pairs of those PTs 65 years (X2 (1)=1.06, p=.304). At death, 61.8% (X2 (1)=31.04 <.001, Φ=.49) with discord at enrollment had discord at death. For patients who were older, 66.7% who had discord at enrollment also had discord at death and for patients

Customized Foot Insoles Have a Positive Effect on Pain, Function, and Quality of Life in Patients with Medial Knee Osteoarthritis

2013 ◽  
Vol 103 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Søren Thorgaard Skou ◽  
Lea Hojgaard ◽  
Ole H. Simonsen
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Older Adults ◽  
Knee Osteoarthritis ◽  
Visual Analog Scale ◽  
Oxford Knee Score ◽  
Analog Scale ◽  
Custom Made ◽  
Arch Support

Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the intervention. We sought to investigate the effect of custom-made laterally wedged insoles on pain, function, and quality of life in patients with medial KOA. Methods: Fifty-one consecutive patients with medial KOA were prescribed custom-made insoles with arch support and a 5.0° to 8.7° lateral wedge. At follow-up, 42 of the 51 participants (22 men; mean age, 63 years; mean Kellgren-Lawrence, 3.4) participated. Retrospectively, participants were asked to rate the pain intensity in their affected knee before and after the intervention measured on a visual analog scale after 30 min of physical activity (primary outcome), at rest, at night, and after 50 m of walking. Additionally, they completed the Oxford Knee Score and the EQ-5D. The paired-samples t test was applied in the statistics. Results: The visual analog scale score after 30 min of physical activity was significantly reduced after the intervention (mean, 3.3 cm; 95% confidence interval, 2.1–4.5 cm; P < .001). The same significant changes were found in all of the secondary outcomes. Conclusions: There was a significant reduction in pain and improvements in function and quality of life with custom-made laterally wedged insoles with arch support in older adults with mild-to-severe medial KOA. The customization of laterally wedged insoles may be essential for the effect in medial KOA. (J Am Podiatr Med Assoc 103(1): 50–55, 2013)

scholarly journals Calidad de vida relacionada con la salud en personas con hipertensión y diabetes mellitus

2021 ◽  
Vol 20 (2) ◽  
pp. 316-344
Author(s):  
Dora Inés Parra ◽  
Luís Alberto López Romero ◽  
Lina María Vera Cala
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Visual Analog Scale ◽  
Intervention Group ◽  
Analog Scale ◽  
Calidad De Vida ◽  
Los Grupos

Objetivo: Determinar los factores sociodemográficos y clínicos asociados a la Calidad de Vida relacionada con la salud (CVRS) en personas con hipertensión arterial y diabetes mellitus tipo 2.Métodos: Estudio analítico de corte transversal en una muestra de 184 usuarios de un programa de control de riesgo cardiovascular en Bucaramanga (Colombia). Se utilizó el instrumento EQ-5D-3L para evaluar la calidad de vida. Un modelo de regresión lineal múltiple fue llevado a cabo usando como desenlace la Escala Visual Análoga y como posibles predictores las dimensiones del EQ-5D, ajustando por edad, sexo, grupo de intervención (variable instrumental) y variables clínicas como la patología de base y el control de la misma.Resultados: La mediana de edad fue 63 años, 73,3% mujeres, 88,0% nivel socioeconómico bajo; mediana de Presión Arterial Sistólica de 130 mmHg (116,0-145,0) y de HbA1c 5,7% (5,4-6,2) en la población general, hallándose diferencias estadísticamente significativas entre los grupos de patología. La mediana de la Escala Visual Análoga fue de 80(Q1:59-Q3:95) puntos, sin diferencias estadísticamente significativas entre los grupos de patología. Manifestar dolor/malestar, tener problemas en las actividades cotidianas y el no control de la hipertensión arterial disminuyó la percepción de la calidad de vida relacionada con la salud, en 7,5, 18,1 y 7,3 puntos, respectivamente.Conclusiones: La CVRS, en general, fue alta. Esta fue mayor en las personas con diabetes mellitus tipo 2. Factores relacionados con la funcionalidad y control de la enfermedad fueron asociados con una menor percepción de la CVRS. Objective: To determine the sociodemographic and clinical factors associated with health-related Quality of Life (HRQoL) among people with hypertension and type 2 diabetes mellitus.Methods: Analytical cross-sectional study in a sample of 184 users of a cardiovascular risk control program in Bucaramanga (Colombia). The EQ-5D-3L instrument was used to assess quality of life. A multiple linear regression model was carried out using the Visual Analog Scale as the outcome and the dimensions of the EQ-5D as possible predictors, adjusting for age, sex, intervention group (instrumental variable), and clinical variables such as the disease and its control.Results: The median of age was 63 years, 73.3% women, 88.0% low socioeconomic level; Median Systolic Blood Pressure of 130 mmHg (116.0-145.0) and HbA1c 5.7% (5.4-6.2) in the general population, showing statistically significant differences between the pathology groups. The median of Visual Analog Scale was 80(Q1: 59-Q3: 95) points, with no statistically significant differences between the pathology groups. Manifesting pain/discomfort, problems with usual activities and lack of hypertension control decreased the perception of HRQoL, by 7.5, 18.1 and 7.3 points, respectively.Conclusions: The HRQoL in general was high. It was higher among people with type 2 diabetes mellitus. Factors related to the functionality and control of the disease were associated with a lower perception HRQoL.

Perceptions of prognosis and goals of care in patients receiving radiation therapy.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 30-30
Author(s):  
Claudia Sofia Roldan ◽  
Jie Jane Chen ◽  
Alexandra N. Nichipor ◽  
Tracy A. Balboni ◽  
Monica Shalini Krishnan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Lung Metastases ◽  
Qualitative Content Analysis ◽  
Metastatic Cancer ◽  
Structured Interviews ◽  
Goals Of Care ◽  
Palliative Radiation Therapy ◽  
Medical Teams

30 Background: We aimed to gain insight into the experiences and perceptions of patients with advanced metastatic cancer surrounding palliative radiation therapy (RT). Methods: In-depth structured interviews were conducted from 9/2016 to 10/2018 with 17 patients with bone or lung metastases receiving their first course of palliative RT. Patient answers about understandings of goals of care and disease prognosis were recorded and analyzed through qualitative content analysis. Medical records were reviewed to obtain demographic and clinical data. Results: The median age of patients was 64 years (range: 21-82). The median survival from time of metastatic diagnosis was 17.6 months (range: 1-46). When asked about goals of RT, qualitative analysis revealed that half (53%) linked receiving palliative RT to improving their quality of life, however 35% believed RT would completely get rid of their tumor. Words that were used commonly throughout patient answers included alleviating pain (41%), cure (29%), and reducing tumor growth (24%). All patients reported they received their information about goals of care from their medical teams. When asked about prognosis, 53% said prognosis had been discussed with them, whereas 76.5% said they were interested in information about prognosis. When asked “What do you believe lies ahead?,” about half (47%) expressed uncertainty about the future, while others (41%) were focused on the next steps in treatment. In the patients interested in learning more about their prognosis, there was a strong preference for this information to come from their medical teams. Conclusions: More than half of patients accurately identified the goal of RT as improving their quality of life, however some patients believed that the palliative RT would cure their tumor. This highlights the ongoing gap in patient provider communication and the need for improvement in this area. Inaccurate perceptions of goals of treatment and prognosis may motivate some patients to pursue unnecessarily aggressive treatments, which could affect quality of life without improving survival. Referrals to radiation oncologists present a potential opportunity to reopen discussions on goals of care and prognosis to adjust patient expectations.

Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Botao Tan ◽  
Lang Jia
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Background and Purpose: This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. Methods: This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analog scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analog scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. Results: A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analog scale, −1.39 [95% CI, −2.41 to −0.36]; P =0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35]; P =0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01]; P =0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41]; P <0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P =0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point ( P =0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analog scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. Conclusions: The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900023513.

The Impact of the Treatment of Pelvic Organ Prolapse with Pessary on Quality of Life and Visual Analog Scale-Case Series

2015 ◽  
Vol 25 (4) ◽  
pp. 282-286
Author(s):  
Burçin KARAMUSTAFAOĞLU BALCI ◽  
Nurcihan ALPER ◽  
Habibe AYYILDIZ ERKAN ◽  
Funda GÜNGÖR UĞURLUCAN ◽  
Önay YALÇIN
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Visual Analog Scale ◽  
Case Series ◽  
Pelvic Organ ◽  
Analog Scale ◽  
The Impact

scholarly journals Comparação do nível de dor femoropatelar, atividade física e qualidade de vida entre adolescentes do sexo feminino e masculino

2017 ◽  
Vol 27 (1) ◽  
pp. 25250 ◽  
Author(s):  
Marina Cabral Waiteman ◽  
Maira Bergamaschi Coura ◽  
Cynthia Gobbi ◽  
Ronaldo Valdir Briani ◽  
Danilo De Oliveira Silva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Knee Pain ◽  
Visual Analog Scale ◽  
Female Adolescents ◽  
Analog Scale ◽  
Public And Private ◽  
Male Adolescents ◽  
Insidious Onset

Aims: To compare the level of pain, physical activity, and quality of life of female and male adolescents with patellofemoral pain.Methods: A total of 46 female adolescents and 46 male adolescents aged 12 to 18 years were recruited from public and private schools in the town of Presidente Prudente, São Paulo, Brazil. To be included in the study, adolescents needed to report knee pain of insidious onset, exacerbated in some activities, and lasting for at least 6 weeks. In addition, adolescents should report worse pain over the previous week of at least 30 mm on the Visual Analog Scale and could not show signs, symptoms or any occurrence of any other knee dysfunction. The participants were requested to mark their self-reported knee pain in the last month on a Visual Analog Scale. The level of physical activity was evaluated by the Baecke Questionnaire of Habitual Physical Activity and the quality of life subscale of the Knee Outcome in Osteoarthritis Survey questionnaire was used to investigate the participants’ quality of life. The independent t-test was used to find differences between the groups regarding the level of physical activity, quality of life, and knee pain.Results: According to the Visual Analog Scale, male adolescents presented a level of knee pain of 5.1±1.4 in the previous month and female adolescents, of 4.4±1.6 (p = 0.029). The physical activity score was 8.8±1.3 for male adolescents and 7.5±1.6 for female ones (p<0.001). The quality of life subscale scores were 77.9±19.0 for adolescent girls and 70.8±13.5 for male adolescents (p=0.042).Conclusions: Among adolescents with patellofemoral pain, males had a higher level of knee pain, higher level of physical activity, and lower quality of life compared to female adolescents.

scholarly journals CT-Guided Pulsed Radiofrequency at Different Voltages in the Treatment of Postherpetic Neuralgia

2020 ◽  
Vol 14 ◽  
Author(s):  
Zhenkai Han ◽  
Tao Hong ◽  
Yuanyuan Ding ◽  
Shimeng Wang ◽  
Peng Yao
Keyword(s):  
Quality Of Life ◽  
Visual Analog Scale ◽  
Postherpetic Neuralgia ◽  
Pulsed Radiofrequency ◽  
Analog Scale ◽  
Ct Guided ◽  
Sf 36 ◽  
Group A ◽  
Group B

BackgroundPostherpetic neuralgia (PHN) is a form of long-lasting neuropathic pain that can severely affect patients’ quality of life. Pulsed radiofrequency (PRF) has been proven to be effective in treating PHN, but the optimal radiofrequency parameters are still not well defined. This retrospective study aimed to compare the efficacy and safety of CT-guided PRF at three different voltages for the treatment of PHN patients.MethodsThis study included 109 patients with PHN involving the thoracic dermatome who were treated in the Department of Pain Management of Shengjing Hospital, China Medical University, from January 2017 to May 2019. They were divided into three groups based on the PRF voltage used: group A (45 V), group B (55 V), and group C (65 V). The PRF therapy (voltage 45, 55, and 65 V) was performed in all patients by targeting the thoracic dorsal root ganglion. After surgery, patients were followed at 3 days, 1 month, 3 months, 6 months, and 12 months. Observation at each follow-up included basic patient characteristics, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) scores, patient satisfaction, complications, and side effects.ResultsVisual analog scale scores decreased and SF-36 scores increased for all patients in the three groups at each post-operative time point (1, 3, 6, and 12 months; all P &lt; 0.01). Pain relief, improvement in quality of life, and overall satisfaction were more significant for patients in group C than for those in groups A and B at the 3-, 6-, and 12-month follow-ups (all P &lt; 0.05). Patients in group B had lower VAS scores and higher overall satisfaction levels than those in group A (both P &lt; 0.01). A small number of patients from each group (n ≤ 3) experienced mild intraoperative and post-operative complications, which bore no relationship with group assignment (all P &gt; 0.05). At post-operative day 3, patients in group C had skin numbness affecting a larger area than patients in the other two groups (both P &lt; 0.05), but the differences were no longer statistically significant at day 30 after the operation. All patients experienced a drop in numbness area of more than 30% after surgery.ConclusionCompared with PFR at 45 and 55 V, PFR at 65 V had superior efficacy in treating PNH, with a favorable safety profile.

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